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 #CNS #RingEnhancing #Lesions #Brain #differential #diagnosis #causes #radiology #neurology
