CPC


۱۴ اردیبهشت ۱۳۸۴



Clinicopathological
 

Conference



Sina Hospital-Tehran




A 31-year-old man was admitted to the hospital

because of an apparent seizure and radiologic

evidence of a cerebral lesion.


The patient had been in excellent health until five

days earlier
, when he felt weak, was briefly unable

to walk, and began to have mild headaches and

dizzy spells, which lasted for several days. A

computed tomographic (CT) scan of the head,

obtained elsewhere, showed a hypodense lesion in

the right parietal lobe. On the day of admission,

uncontrollable flailing of the right arm and leg

developed. The patient was referred to this

hospital.



The patient was a research worker involved in a

trial of a human immunodeficiency virus (HIV)

vaccine; he had no contact with patients. Eighteen

months before admission, he had participated in a

field study in Uganda; a test for HIV antibodies had
been negative on his arrival there. He had received

vaccines against viral hepatitis A and B, typhoid

fever, and yellow fever. During his stay in Africa, he
also traveled to Kenya and Tanzania, rafted once

on the Nile, and frequently swam in and sailed on

Lake Victoria
, five months before admission. He

consumed a variety of meats, which included well-

cooked pork. He had had a bout of diarrhea and

fever one year before admission and again five

months later; each bout lasted two days. His only

medication was mefloquine (250 mg once a week).

He had been accompanied in Africa by his wife,

who remained well.


The temperature was 36.3°C, the pulse was 60,

and the respirations were 18. The blood pressure

was 140/80 mm Hg. Physical, neurologic, and

ophthalmologic examinations revealed no

abnormalities. The urine was normal. Laboratory

tests were performed A magnetic resonance

imaging (MRI) study of the brain (Figure 1),

performed after the administration of gadolinium,

showed an ill-defined, irregular area of abnormal

enhancement, 3.5 cm in maximal diameter, in the

right parietal lobe, with increased intensity of the

signal on the T1-weighted image; some of the

enhancement within and posterior to the lesion

appeared to indicate leptomeningeal involvement.

This finding was consistent with a breakdown of the
blood–brain barrier; the finding of a surrounding

area of low attenuation was consistent with the

presence of edema. 

 
Proton spectroscopy showed an elevation of

choline resonance in relation to creatinine (1.66:1.0)
and a decrease in N-acetyl aspartate; this finding is

consistent with inflammation. A small lactate doublet
was present. Radiographs of the chest showed no

abnormalities. Microscopical examination of urine

and stool specimens disclosed no ova or parasites.

A tuberculin skin test (5 TU), performed without

controls, was negative at 72 hours. A lumbar

puncture was performed (Table 3).

A diagnostic procedure was

performed.


 


 


 


 


 


 



منبع: بيمارستان سينا دانشکده پزشکي