A 51-year-old man presented with headache, paresthesias of the legs and arms, and seizure. MRI showed multiple cystic lesions with dot sign and gadolinium enhancement (Figures 1 and 2). The findings are reported to be pathognomonic of neurocysticercosis in the colloidal stage; however, brain tumors and cryptococcosis can mimic it. In this case, Cryptococcus gattii was isolated from the CSF. Despite treatment with amphotericin B and fluconazole, the patient died. There are important imaging differences between neurocysticercosis and cryptococcosis. In neurocysticercosis, usually there is no postcontrast enhancement of the dot sign. Cryptococcosis encephalitis is a difficult-to-treat disease that can affect immunosuppressed or immunocompetent patients.1,2
(A) Axial T2WI shows multiple cystic lesions, one in the left occipital lobe with dot sign (arrows in A and B). Axial fluid-attenuated inversion recovery shows vasogenic edema around most lesions (C). Axial T1WI postgadolinium shows peripheral and dot sign enhancement (D). Dot sign is a nodule within a cystic lesion.
(A) Axial T2WI shows 2 cystic lesions in the right cerebellar hemisphere with dot sign (arrows in A and B). Axial DWI shows dot sign (arrow in C). Axial T1WI postgadolinium shows nodular and dot sign enhancement (arrow in D).
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Footnotes
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