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Images in Neurology |

What Can be Worse Than Cerebral Tuberculosis?  A Concommitant Aspergillus Infection

Sevasti Bostantjopoulou, MD; Zoe Katsarou, MD; Ioannis Tsitouridis, MD; Paul Nicolaidis, MD; Vassilios Kimiskidis, MD; Aristidis Kazis, MD
Arch Neurol. 2003;60(8):1163-1164. doi:10.1001/archneur.60.8.1163.
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A 21-YEAR-OLD woman had right leg weakness in May 2000. On examination, she had horizontal nystagmus and right pyramidal signs. Her hematologic, biochemical, chest radiograph, and cerebrospinal fluid findings were normal. Magnetic resonance imaging of the brain (Figure 1) revealed an area with increased enhancement in the left parietal lobe, but no specific diagnosis could be established. The patient recovered fully; however, 6 months later, she developed symptoms and signs of pulmonary tuberculosis (TBC) and was treated with anti-TBC medication.

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Figure 1.

Coronal postcontrast, T1-weighted image reveals an area of increased enhancement in the left parietal lobe.

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Figure 2.

Axial and coronal T1-weighted images 10 months after the first magnetic resonance imaging scan. A, Precontrast image shows low-intensity signal in the left parietal lobe. B and C, Postcontrast images of the same area show a ring-enhancing lesion surrounded by edema.

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Figure 3.

Coronal postcontrast, T1-weighted image 2 years after the first magnetic resonance imaging scan reveals only a small area of enhancement in the previous large area of lesion involvement.

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