Slide 1

A 41 year old African patient with multifocal neurology Teaching NeuroImages Neurology Resident and Fellow Section 2013 American Academy of Neurology

Slide 2

A 41 year old female patient originally from West Africa presented with 3-week history of generalized weakness. Clinical examination presented quadriparesis, urinary incontinence and reduced level of consciousness. Maroski et al.

Slide 3

Slide 4

The imaging of neuroaxis revealed multiple bilateral cerebral lesions including basal ganglia and midbrain. Spinal cord imaging showed lesions in conus medullaris (Figure). The HIV test was reactive with a CD4 count of 10 cells/ L (normal range: 700- 1 200/ L). CSF PCR for Toxoplasma gondii was positive. CSF cryptococcal antigen, fungal and mycobacterial cultures, EBV-PCR and M.tuberculosis-PCR were negative. Conus medullaris involvement is an uncommon manifestation of toxoplasmosis in advanced HIV. Maroski et al.