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Multiple Ring-Enhancing Brain Lesions: Fulminant Diffuse Cerebral Toxoplasmosis or Cerebral Metastases?

Sebastiaan De Keersmaecker1,2, Sofie Van Cauter2, Kim Bekelaar2

  • 1KU/UZ Leuven, Leuven, Belgium; and.

Topics in Magnetic Resonance Imaging : TMRI
|April 10, 2024
PubMed

Insights

This case report highlights a 76-year-old woman with dizziness and multiple ring-enhancing brain lesions. The lesions were ultimately diagnosed as metastatic small cell lung carcinoma, underscoring the need for broad differential diagnoses in neuroimaging.

Area of Science:

  • Neurology
  • Oncology
  • Radiology

Background:

  • Dizziness and neurological deficits can indicate serious underlying conditions.
  • Ring-enhancing lesions on brain MRI require thorough investigation.

Observation:

  • A 76-year-old woman presented with 2 months of dizziness and multiple supratentorial and infratentorial ring-enhancing brain lesions on MRI.
  • Initial presentation mimicked cerebral abscesses, leading to antibiotic treatment.
  • Cerebrospinal fluid analysis was unremarkable.

Findings:

  • Further workup revealed stage IV metastatic small cell lung carcinoma as the cause of the brain lesions.
  • The patient received whole-brain radiotherapy but experienced clinical deterioration.

Implications:

  • This case emphasizes the critical importance of a broad differential diagnosis for ring-enhancing brain lesions.
  • Metastatic disease, particularly from lung cancer, should be considered in the differential diagnosis.
  • Prompt diagnosis and management are crucial, even in palliative care settings.

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