Images in Clinical Medicine
Kim Eagle, M.D., Editor
Brain Herniation in Toxoplasmosis
N Engl J Med 1994; 331:711September 15, 1994
- Article
Figure 1 Brain Herniation in Toxoplasmosis.
A computed tomographic scan of the head (Panel A) shows subfalcial brain herniation in an outpatient who was seropositive for the human immunodeficiency virus and who had subtle changes in cognitive function but an otherwise normal neurologic examination. A ring-enhancing mass with irregular borders measuring 1.8 by 1.4 cm is present in the left basal ganglia (short arrow), associated with marked edema (arrowhead). The mass effect has caused compression of the left lateral ventricle, with a 0.8-cm ventricular shift toward the right (long arrow) and displacement of the falx cerebri to the right of midline (in a manner consistent with subfalcial herniation). The patient was seropositive for toxoplasma antibodies and was treated with pyrimethamine, leucovorin, and clindamycin. Panel B shows the near-complete reversal of the changes after six weeks of therapy. Four months after treatment ended, the patient had no overt cognitive disturbances.
Kim Eagle, M.D.
Nina Singh, M.D.
Kevin Stempel, M.D.
Veterans Affairs Medical Center, Pittsburgh, PA 15240
