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A 41-year-old woman has had a worsening headache for the past week, along with a fever and increasing obtundation. On physical examination her temperature is 38.2 C. A head CT scan reveals a solitary 3 cm diameter lesion with ring enhancement located in the right parietal lobe. A stereotactic biopsy is performed and a frozen section shows granulation tissue with adjacent collagenization, gliosis, and edema. Which of the following is the most likely diagnosis?

A Chronic brain abscess

B Aspergillosis

C Progressive multifocal leukocencephalopathy

D Toxoplasmosis

E Rabies virus infection




D Toxoplasmosis
with ring enhancement located


brainstem wrote:



also brain abscess causes ring enhancement did u pick toxo?


maoudoody wrote:
also brain abscess causes ring enhancement did u pick toxo?

yup you are right got sucked into the Ring and Toxo relation

i will neeed to look it up to make sure about in terms of histological picture presented.


Yup Maudoody you are right

The histopathological picture of Toxoplasmosis would show hemorrhage and necrosis. while an abcess would show the following.

CT manifestations of an intracranial abscess depend on the stage of the abscess formation. The earliest phase may be related to meningitis, with no findings on unenhanced CT studies. Enhancement of the meningeal surfaces is a nonspecific and inconsistent finding in patients with meningitis.

  • During early cerebritis, nonenhanced CT scans may demonstrate normal findings or may show only poorly marginated subcortical hypodense areas.
  • Contrast-enhanced CT studies demonstrate an ill-defined contrast-enhancing area within the edematous region.
  • During the early stage of a formed abscess, the lesion coalesces, with an irregular enhancing rim that surrounds a central low-attenuating area.
  • Scans obtained with a time delay following contrast enhancement in cerebritis may show contrast "filling in" the central low-attenuating region. A formed abscess will not "fill in" the central portion of the abscess.
  • Peripheral edema results in considerable mass effect with sulcal obliteration.
  • The early capsule stage is characterized by a distinct collagenous capsule.
  • A relatively thin well-delineated capsule marks the final stage of a fully formed abscess.

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