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BMJ Case Reports 2016; doi:10.1136/bcr-2016-215676

Reversible movement disorders due to toxoplasmosis as initial manifestation of HIV-AIDS, with sequential MR and video imaging

  1. Nathaniel Duke4
  1. 1Neurology Unit, Department of Medicine, San Fernando Teaching Hospital, San Fernando, Trinidad and Tobago
  2. 2Department of Medicine, San Fernando Teaching Hospital, San Fernando, Trinidad and Tobago
  3. 3Department of Medicine, Surgi-Med Clinic, San Fernando, Trinidad and Tobago
  4. 4Infectious Disease Unit/Medicine, San Fernando Teaching Hospital, San Fernando, Trinidad and Tobago
  1. Correspondence to Dr Kanterpersad Ramcharan, kramcharan79{at}yahoo.com
  • Accepted 29 May 2016
  • Published 16 June 2016

Description

A previously well 22-year-old African man had cognitive decline for 1 month and involuntary movements for 10 days. Video in segment 1 showed right-sided choreoathetosis. Segment 2, day 6, after 5 days of treatment (table 1) demonstrated less choreoathetosis and brief dystonia of the right foot. Segment 3, on day 10 exhibited normality. The patient scored 5/30 on the Mini Mental State Examination (MMSE). Investigations showed HIV-AIDS associated with secondary syphilis and also a third condition, central nervous system (CNS) toxoplasmosis (table 2). MRI scan of the brain showed cystic and solid areas with hyperintensities and perilesional oedema in some areas on T2-weighted and fluid-attenuated inversion recovery sequences and low signal on T1-weighted imaging in the right parietal-temporal lobes and in the frontal regions, basal ganglia and thalamus bilaterally. The cystic lesions also demonstrated restricted diffusion on diffusion-weighted imaging/apparent diffusion coefficient-weighted images (figure 1 …

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