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CEREBRAL TOXOPLASMOSIS, image - Coggle Diagram
CEREBRAL TOXOPLASMOSIS
Anatomy of Cerebrum
Parts
- Consists of two hemispheres (left and right), each divided into five lobes; frontal, parietal, temporal, occipital, insular.
- Structurally composed of an outer layer of gray matter (cerebral cortex) and centrally located white matter.
- It is supplied by the middle and posterior cerebral arteries.
Function
- Integrates and consolidates neural information and initiates and coordinates voluntary activity.
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Defenition, Etiology & Risk Factor
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Risk Factor
- Male> Female
- Tropical climate
- Immunocompromised
- Eating undercooked meat of animals harboring tissue cysts
- Poor hygiene
Defenition
Recurrence of toxoplasmosis from latency is a frequent cause of toxoplasmic encephalitis (TE) in people with immunosuppressive conditions such as advanced HIV infection, organ transplantation, and neoplastic disease, or in those receiving immunosuppressive therapies (e.g., rituximab).
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Differential Diagnosis
- Hypoxia
- Hypo- or Hypernatremia
- Hypo- or Hyperglicemia
- Dehydration
- Traumatic brain injury
- Stroke
- Intracranial hemorrhage
- Encephalitis.
- Neoplasms within the intracranial cavity
- Drugs Induce ( alcohol)
Diagnosis Approach
- Serologic studies in patients with CNS toxoplasmosis may demonstrate rising titers of anti-toxoplasma immunoglobulin G (IgG) antibodies. An immunoglobulin M (IgM) antibody response is seen in cases of newly acquired toxoplasmosis or Toxoplasma encephalitis.
- CSF findings may also include elevated protein and variable glucose and WBC counts.
- Single or multiple hypodense or hypointense lesions in white matter and basal ganglia with mass effects may be observed on CT or MRI scans. Lesions may enhance in a homogeneous or ring pattern with contrast
- Brain Biopsy (High-magnification photomicrograph shows a tissue cyst and tachyzoites in the brain parenchyma.)
Treatment & Education
- Standard therapy consists of pyrimethamine, sulfadiazine, and folinic acid in combination. Trimethoprim-sulfamethoxazole (TMP-SMZ) can be used as an alternative regimen
- Sulfadiazine: 1000 mg 4 times daily among patients < 60 kg or 1500 mg four times a day among patients >60 kg.
- Pyrimethamine: 200 mg loading dose followed by 50 mg daily among patients< 60 kg or 75 mg daily among patients >60 kg.
- Leucovorin should be administered to prevent pyrimethamine induced hematologic toxicity. Dose can be 10-25 mg daily.
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