Teaching Neuro Images : Conus medullaris involvement in cerebrospinal toxoplasmosis

Abstract

A 41-year-old woman originally from West Africa presented with a 3-week history of generalized weakness. Clinical examination demonstrated quadriparesis, urinary incontinence, and reduced level of consciousness. The imaging of the neuraxis revealed multiple bilateral cerebral lesions, including basal ganglia and midbrain. Spinal cord imaging showed lesions in the conus medullaris (figure). The HIV test was reactive, with a CD4 count of 10 cells/µL (normal range 700–1,200/µL). CSF PCR for Toxoplasma gondii was positive. CSF cryptococcal antigen, fungal and mycobacterial cultures, Epstein-Barr virus PCR, and Mycobacterium tuberculosis PCR were negative.