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How Good at Neurology are you? – Answers


1. Cerebral toxoplasmosis with AIDS.

Multiple hypodense lesions in the deep regions of the brain are fairly typical of toxoplasmosis. The oral candidiasis had already suggested immunological incompetence. Failure to enhance with contrast is consistent with severe suppression of cellular immunity, confirmed by a very low CD4 count. The patient improved on treatment with a combination of antiretroviral drugs, sulphadiazine and pyrimethamine and could eventually return home.

Further Reading

Ramsey RG, Gean AD (1997) Neuroimaging of AIDS. I. Central nervous system toxoplasmosis. Neuroimaging Clin N Am, 7, 171–86.

2. Intoxication with anticholinergic drugs.

On further questioning it emerged that an older brother had been scheduled for a follow up appointment with an ophthalmologist - a bottle with eye drops to be administered before the repeat visit was kept in the fridge at home. A telephone call to the home, where grandmother kept an eye on the other children, revealed

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