CNS Ring-Enhancing Lesions - Immunocompromised vs Immunocompetent

Multiple Ring-Enhancing Lesions:

 • Toxoplasmosis (CD4 < 100)

 • Other manifestations- Pneumonitis, Chorioretinitis

 • Diagnosis- Compatible syndrome + MRI lesions + toxo IgG

 • CNS PCR 50% sensitive

Lymphomatoid granulomatosis:

 • EBV-associated lymphoproliferative disease

 • 30% present w/ CNS lesions

 • 80% with lung nodules, may also see skin lesions, LAD, and hepatomegaly/splenomegaly

Other infections including: M, avium, TB, histoplasmosis, cryptococcus, and aspergillus

Solitary Lesion:

 • CNS Lymphoma (CD4 <100), 25% with multiple lesions

Infectious:

 • Bacterial

 • Tuberculosis

 • Syphilis

 • Pyogenic Abscess

 • Nocardia

 • Parasitic

 • Neurocysticercosis

Malignancy:

 • Glioblastoma

 • Metastatic disease

Inflammatory:

 • Multiple Sclerosis and other demyelinating diseases (often form an incomplete ring)

 • Sarcoidosis

 • Neuro Behcets

Vascular lesions



Dr. Ann Marie Kumfer @AnnKumfer



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