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Incidental ring-shaped cerebral lesions in a 3-year-old
  1. Rebecca Borg,
  2. David Pace
  1. Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta
  1. Correspondence to Dr Rebecca Borg; rebecca.c.borg{at}gov.mt

https://doi.org/10.1136/archdischild-2024-326860

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    A 3-year-old girl, adopted from India, presented with left hemiparesis and a history of hypoxic-ischaemic encephalopathy. She had no history of seizures. MRI showed sequelae of left parietal periventricular ischaemia. However, incidentally, 11 scattered small ring-shaped low-T2 signal lesions, uniform in size, with mild surrounding oedema on FLAIR (Fluid-Attenuated Inversion Recovery) were seen (figure 1). A visible scolex was seen centrally on T2 sequences.

    Figure 1

    Axial views of the MR brain (susceptibility-weighted imaging, with contrast) showing moderate loss of left parietal periventricular white matter associated with dilatation of the trigone of the left lateral ventricle on T2 (A) suggestive of a history of periventricular ischaemia and multiple intracerebral ring-enhancing lesions (white arrows on (B) and (C)). Coronal FLAIR (Fluid-Attenuated Inversion Recovery) view (D) showing mild perilesional oedema (white arrow).

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    1. What is the most likely diagnosis?

      1. Congenital toxoplasmosis

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    Footnotes

    • Contributors RB is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.