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Type 3 Odontoid Fracture
Joseph Junewick, MD FACR
over 8 years ago
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ARSt Case Repository

Congenital Toxoplasmosis

Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 8 years ago
Updated: over 8 years ago
Tags: PEDS
Modality/Study Types: MR
Activities:
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History

Full-term newborn with seizure at 8 hours of life.


Case Images


Diagnosis

Congenital Toxoplasmosis

Clinical Notes

Lumbar puncture – high protein.

Toxoplasmosis IgG titer – positive.

Findings

MR Spine – Focal expansion of the cervico-thoracic cord and conus medullaris with T2 and postgadolinium hyperintensity.

MR Brain – Right oculus is small with abnormal vitreal signal. Extensive encephaloclastic change in the cerebrum, cerebellum and deep gray/white matter tracts with areas of encephalomalacia and mineralization. Note the enhancement of all three compartments (leptomeningeal, parenchymal, and intraventricular).

Discussion

Toxoplasmosis is one of the “TORCH” infections. Transplacental or transvaginal transfer of infection in the first half of pregnancy results in severe congenital malformations; later infections result in varying degrees of CNS destruction.

Toxoplasmosis infection is secondary to exposure to the parasite Toxoplasma gondii. Oocysts of this parasite are inadvertently ingested through contact with feces of mammals (predominantly cats) and birds. Toxoplasmosis infection is much less common than CMV.

Principle findings include hydrocephalus, abnormal CSF, chorioretinitis, and parenchymal calcifications. Before 20 weeks gestation, severe CNS destruction occurs. After 20 weeks gestation, outcome is variable with areas of necrosis and calcification (cortical and periventricular). Cortical malformations and ventriculomegaly which are common in CMV infection are unusual with toxoplasmosis.

Reference

Hall SM. Congenital Toxoplasmosis. BMJ 1992;305:291-297.



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