Single thalamic localization of brain toxoplasmosis mimicking brain tumors: Radiological and clinical findings

A Report of a Rare Case of a Solitary Ring-Enhancing Lesion in a Patient With Positive Toxoplasma Serology

Ring-enhancing lesions are typically observed in patients with immunosuppression caused by underlying conditions such as HIV/AIDS or cancer. These lesions can arise from various etiologies, including infections, neoplasms, or vascular conditions. This case involves a male in his 30s from South America who presented to the emergency department after experiencing a seizure episode. He had no significant prior medical history and reported that he had not seen a doctor since childhood. A comprehensive workup was initiated during his hospitalization, including brain imaging that revealed a solitary ring-enhancing lesion. The evaluation encompassed brain CT and MRI, along with infectious labs measuring inflammatory and serological markers for several diseases. An infectious disease consultant was engaged to assist in developing a thorough assessment and management plan. Throughout the hospitalization, the patient exhibited a benign physical exam with no neurological deficits, remained afebrile, and displayed insignificant white blood cell counts and negative blood cultures. Serological test results were all negative for HIV, rapid plasma reagin, and tuberculosis, except for a positive Toxoplasma gondii IgG antibody level. This case is noteworthy because the patient presented with a solitary ring-enhancing lesion in the brain resulting from a prior T. gondii infection, despite the absence of documented risk factors for this condition.

The Role of MicroRNAs in HIV Infection

MicroRNAs (miRNAs), a class of small, non-coding RNAs, play a pivotal role in regulating gene expression at the post-transcriptional level. These regulatory molecules are integral to many biological processes and have been implicated in the pathogenesis of various diseases, including Human Immunodeficiency Virus (HIV) infection. This review aims to cover the current understanding of the multifaceted roles miRNAs assume in the context of HIV infection and pathogenesis. The discourse is structured around three primary focal points: (i) elucidation of the mechanisms through which miRNAs regulate HIV replication, encompassing both direct targeting of viral transcripts and indirect modulation of host factors critical for viral replication; (ii) examination of the modulation of miRNA expression by HIV, mediated through either viral proteins or the activation of cellular pathways consequent to viral infection; and (iii) assessment of the impact of miRNAs on the immune response and the progression of disease in HIV-infected individuals. Further, this review delves into the potential utility of miRNAs as biomarkers and therapeutic agents in HIV infection, underscoring the challenges and prospects inherent to this line of inquiry. The synthesis of current evidence positions miRNAs as significant modulators of the host-virus interplay, offering promising avenues for enhancing the diagnosis, treatment, and prevention of HIV infection.

Stereotactic placement of dual lumen catheter system for continuous drainage, irrigation, and intraventricular antibiotic therapy for treatment of brain abscess with ventriculitis - A case report and literature review

Background

Cerebral abscesses complicated by ventriculitis present significant treatment challenges, often associated with high morbidity and mortality. Traditional management approaches, including systemic antibiotic therapy and external ventricular drainage (EVD), face limitations due to the blood-brain barrier and risks of catheter-related complications. This report discusses a case where the dual-lumen catheter system, an innovative neurosurgical tool integrating continuous irrigation with drainage, was employed.

Case Description

A patient presented with a cerebral abscess ruptured into the ventricle, leading to ventriculitis. Conventional treatment options were limited due to the abscess's deep and eloquent location and the associated risk of complications from standard EVD. The dual lumen system was chosen for its ability to provide continuous irrigation and drainage, effectively addressing issues of catheter blockage and enhancing localized antibiotic delivery. The system was used to create a single stereotactic tract for simultaneous treatment of the abscess and ventriculitis. This approach allowed for a more controlled and effective treatment process, resulting in rapid resolution of the conditions without chronic hydrocephalus development or further complications.

Conclusion

The use of the dual lumen system represented a significant advancement in this case, addressing the limitations of conventional treatments. Its ability to maintain intracranial pressure within optimal limits while providing localized, continuous treatment was pivotal. This case highlights the potential of the dual lumen catheter in managing complex neurosurgical infections and underscores the need for further research to establish its efficacy in broader clinical applications.