Question: A 37 year-old patient with acquired immunodeficiency syndrome (AIDS) presents with a 6 week history of progressive right sided weakness and headache. Magnetic resonance imaging (MRI) shows a left periventricular uniformly enhancing mass lesion. Which of the following diagnoses is most likely?
A. Toxoplasmosis
B. Abscess
C. Astrocytoma
D. Meningioma
E. Lymphoma
Answer Explained
Central nervous system (CNS) lymphoma is a complication of AIDS. It can present with focal neurologic deficits and is often in a periventricular location. CNS lymphoma is typically uniformly enhancing on MRI. Toxoplasmosis typically has multiple small enhancing lesions. An abscess can occur in any brain location, and typically the periphery of the lesion enhances. Similarly, an astrocytoma enhances about the periphery, and usually originates in the hemispheral white matter locations. A meningioma often enhances uniformly, but a periventricular location would be most unusual.
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