Case Report of a 52 Year Old Hypertensive with Cerebral Toxoplasmosis as a Stroke Mimic

Abstract

Background The diagnosis of acute ischaemic stroke is sometimes straightforward. The sudden onset of  a focal neurologic deficit in a recognizable vascular distribution with a common presentation - such as  hemiparesis, facial weakness and aphasia - identifies a common syndrome of acute stroke. I But differential diagnostic problems remain because there are some non-vascular disorders which "mimic"  stroke. Such mimics have clinical pictures that appear identical to stroke. I However, standard acute neuroimaging with non-contrast CT scanning will discover some of these mass lesions mimicking stroke. We therefore present a brief case report on cerebral toxoplasmosis as a stroke mimic

Methods The case records of a patient who presented with cerebral toxoplasmosis mimicking a stroke and a review of the literature using google, Medline and PubMed search as well as available literature on the subject were utilized.

Results We present a 52 year banker, a known hypertensive of2 years duration who claims good  adherence to medications. He presented to us 16 days after he a history of inability to move the left side  of his body and other neurologic features suggestive of a right hemispheric ischaemic stroke. Brain CT showed features of cerebral toxoplasmosis and he was found to be seropositive HIV 1. The patient was  placed on pyrimethamine, sulphadiazine, dexamethasone, antihypertensives and HAART. He made  remarkable improvement on discharge and follow up.

Conclusion It is important for physicians to have a high index of suspicion for stroke mimics and ensure that radiologic brain imaging is done in all suspected stroke patients in order to ensure appropriate  diagnosis and treatment as in this index case.