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[Spinal cord toxoplasmosis and AIDS]
M Carteret1, E Petit, O Granat
1Service de Radiologie, Hôpital Saint-Joseph, Paris.
Journal De Radiologie
|July 1, 1995
Summary
Toxoplasmosis, a common brain infection in AIDS patients, can also affect the spinal cord. Early MRI diagnosis and treatment are crucial for managing this rare but serious complication.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Toxoplasmosis is the most frequent parasitic brain infection in individuals with acquired immunodeficiency syndrome (AIDS).
- Spinal cord involvement in toxoplasmosis is rare, with limited documented cases, often associated with concurrent cerebral lesions.
- This study presents a unique case of concurrent spinal cord and cerebral toxoplasmosis in an AIDS patient.
Observation:
- Magnetic Resonance (MR) imaging revealed a focal enlargement of the conus medullaris, appearing iso intense on T1 and hyperintense on T2 weighted sequences.
- The lesion demonstrated homogeneous enhancement post-Gadolinium contrast administration, accompanied by medullary edema.
- Clinical improvement was observed following treatment initiation, with follow-up MR imaging showing normalization of the conus medullaris and resolution of enhancement.
Findings:
- The case highlights the potential for toxoplasmosis to manifest as a single spinal cord lesion, even without apparent cerebral involvement.
- MR imaging is a valuable tool for diagnosing spinal cord toxoplasmosis, showing characteristic features of inflammation and enhancement.
- Prompt treatment without corticosteroids led to significant clinical and radiological improvement.
Implications:
- Spinal cord lesions in AIDS patients, whether isolated or associated with brain involvement, should be presumed to be toxoplasmosis.
- MR imaging follow-up is recommended to monitor treatment response and avoid unnecessary invasive procedures like medullary biopsy.
- Cerebral toxoplasmosis lesions can sometimes mask or overshadow concurrent spinal cord involvement, emphasizing the need for comprehensive diagnostic evaluation.