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NEUROIMAGE
Year : 2015  |  Volume : 63  |  Issue : 6  |  Page : 1001-1002

Large unilateral brain stone in TORCH infection


Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India

Date of Web Publication20-Nov-2015

Correspondence Address:
Dr. Venkatraman Indiran
Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, 7 Works Road, Chromepet, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.170100

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How to cite this article:
Indiran V. Large unilateral brain stone in TORCH infection. Neurol India 2015;63:1001-2

How to cite this URL:
Indiran V. Large unilateral brain stone in TORCH infection. Neurol India [serial online] 2015 [cited 2019 Dec 10];63:1001-2. Available from: http://www.neurologyindia.com/text.asp?2015/63/6/1001/170100


A 30-year-old woman was brought with a history of recurrent seizures, right hemiparesis, and speech difficulty since she was 3 years of age. A large lobulated calcification was seen on the left of midline in her skull radiograph [Figure 1]a. Her computed tomography and magnetic resonance imaging of the brain revealed atrophy of the left cerebral hemisphere and encephalomalacia, ex vacuo dilatation of the left lateral ventricle, atrophic left half of the brainstem, right cerebellar hemispheric atrophy (crossed cerebellar diaschisis), and a large calcification (~4 cm × 3 cm) with lobulated margins in the left basal ganglia [Figure 1]b,[Figure 1]c,[Figure 1]d. The left middle cerebral artery and A2 segment of the left anterior cerebral artery were not visualized on magnetic resonance angiogram [Figure 2]. Though the calcification prompted differentials of calcified sphenoid wing meningioma, oligodendroglioma or metastasis, her clinical history along with findings of dystrophic basal ganglia calcification and cerebral hemiatrophy were more suggestive of all these findings being a sequel of TORCH (toxoplasmosis, rubella, Cytomegalovirus [CMV], and herpes simplex virus [HSV]) infection. The patient's serological IgG TORCH panel was significantly positive for CMV (130.7 U/ML), toxoplasma (18.81 IU/ML), and HSV I (3.35 units). Antiepileptic drugs were prescribed for the management of seizures.
Figure  1:  (a) Skull radiograph shows a lobulated calcification  (black arrows) on the left side. (b) Computed tomography reveals left cerebral hemisphere atrophy, encephalomalacia, dilated left lateral ventricle, and left basal ganglia calcification  (black arrow). (c) Axial and coronal T2 images on magnetic resonance imaging reveal left cerebral hemisphere atrophy, encephalomalacia, dilated left lateral ventricle  (white arrow), and hypointense left basal ganglia calcification  (black arrow). (d) Axial T1 images reveal left basal ganglia calcification with hypointense rim  (black arrow) and right cerebellar hemisphere atrophy  (white arrow)

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Figure  2: Coronal maximum intensity projection of magnetic resonance angiogram of the brain shows absence of left middle cerebral artery and A2 segment of left anterior cerebral artery

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TORCH agents are the most common cause of fetal central nervous system infections. Basal ganglia and cortical calcifications are the common features of the TORCH syndrome.[1] Congenital HSV infections demonstrate extensive cerebral destruction, multicystic encephalomalacia, and scattered calcifications.[2] Congenital toxoplasmosis is associated with hydrocephalus and random nodular calcifications in the periventricular region, basal ganglia, and cerebral cortical areas.[3] CMV is associated with microcephaly, chorioretinitis, and intracranial (periventricular and subependymal) calcifications.[4] Although calcifications in TORCH infections usually tend to be bilateral and fine, occasionally, a unilateral, large chunky calcification (brain stone) may also be a presentation that one must be aware of.

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 » References Top

1.
Popli MB, Popli V. Congenital toxoplasmosis infection. Neurol India 2003;51:125.  Back to cited text no. 1
    
2.
Benator RM, Magill HL, Gerald B, Igarashi M, Fitch SJ. Herpes simplex encephalitis: CT findings in the neonate and young infant. AJNR Am J Neuroradiol 1985;6:539-43.  Back to cited text no. 2
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3.
Hedlund GL, Boyer RS. Neuroimaging of postnatal pediatric central nervous system infections. Semin Pediatr Neurol 1999;6:299-317.  Back to cited text no. 3
    
4.
Fink KR, Thapa MM, Ishak GE, Pruthi S. Neuroimaging of pediatric central nervous system Cytomegalovirus infection. Radiographics 2010;30:1779-96.  Back to cited text no. 4
    


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