Thinking outside the cranium.

TL;DRAbstract

Cerebral toxoplasmosis is a leading cause of central nervous system (CNS) lesions in severely immunocompromised human immunodeficiency virus+ (HIV+) patients who are seropositive for the parasite and have not received effective chemoprophylaxis. A 48-year-old HIV+ woman presented to our emergency room with seizure and decreased level of consciousness. She had developed fever, productive cough, and malaise 1 week prior to her current admission. Multifocal sensory and motor deficits in her extremities were revealed on neurologic examination. The brain imaging of our patient showed a distinctive ring-enhancing lesion that narrowed our differential diagnosis considerably. The patient was admitted on January 20, 2009 with decreased level of consciousness, urinary incontinence, upward eye deviation, right arm tonic flexion and right leg clonic jerks while the left extremities were tonically extended. Her seizure was controlled with intravenous diazepam and phenytoin, and she was fully con

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