朗读老师：章维昆明医院
翻译老师：司医院
History:A48-year-oldwomanpresentswithsubacuteweaknessthatisgreaterontherightthanleft,pronatordrift,dyspneaonexertion,hypoesthesiaofherfeet,anddysgeusia.
AnunenhancedCTscanwasperformed.Axialimageisshownbelow.
病史：一位48岁女性，表现为亚急性虚弱，右侧大于左侧，旋前肌漂移，用力时呼吸困难，足部感觉减退，以及味觉障碍。
进行平扫CT扫描。轴向图像如下所示。
MRimages
AbrainMRIscanwasperformed.Axialfluid-attenuatedinversion-recovery(FLAIR)andaxialT1-weightedpostcontrastimages,aswellasanaxialapparentdiffusioncoefficient(ADC)map,areshownbelow.Clicktoenlarge.
进行脑部核磁共振扫描。轴位液体衰减反演恢复（FLAIR）和轴位T1加权增强后图像以及轴位表观扩散系数（ADC）图如下所示
Findings
HeadCT
herearemultipleareas,includingthetemporallobes,ofhypoattenuationinthewhitematterbilaterallyconsistentwithvasogenicedema.Thereismildmasseffectassociatedwithregionsofvasogenicedema.Thereismilddiffusesulcaleffacement.
结果
?头颅CT：双侧白质有多个区域（包括颞叶）低密度，与血管源性水肿一致。与血管源性水肿相关的区域有轻微的占位效应。轻度弥漫性脑沟消失。
HeadMRI:MRIshowsmultipleinfra-andsupratentoriallesionswithsurroundingvasogenicedema,andmanyofthemhaveanalternatingpatternofhypo-andhyperintensesignalonT2-weighted/FLAIRimaging--i.e.,theso-calledtargetpatternofenhancement.Thereisnoevidenceofrestricteddiffusionandnoevidenceofabnormalmeningealenhancement.
头部MRI：MRI显示多个幕下和幕上病变，周围有血管源性水肿，其中许多在T2加权/FLAIR成像上呈低信号和高信号交替模式，即所谓的增强后靶征。没有证据表明扩散受限，也没有证据表明脑膜异常强化。
Differentialdiagnosis
Neurotoxoplasmosis
Metastaticdisease
Bacterialinfectionwithabscess
Centralnervoussystemlymphoma
Diagnosis:Neurotoxoplasmosis
鉴别诊断
脑弓形虫感染
转移性疾病
细菌感染伴脓肿
中枢神经系统淋巴瘤
诊断：脑弓形虫感染
Discussion
Neurotoxoplasmosis
Pathophysiology
Toxoplasmagondiiisaparasitethatisusuallyasymptomaticinimmuno
