Teaching NeuroImages: Balamuthia mandrillaris amebic encephalitis: Clinical-radiologic-pathologic correlation

A 32-year-old immunocompetent man presented with new-onset generalized tonic-clonic seizures. On examination, he had mild right hand weakness, with right-sided Hoffman sign, ankle clonus, and Babinski reflex present. MRI of the brain demonstrated vasogenic edema surrounding a ring-enhancing lesion in the left parietal lobe (figure, A). Repeat brain MRIs showed rapid progression of the lesion, with new lesions appearing in the contralateral hemisphere (figure, B and C). Pathology showed necrotizing meningoencephalitis with organisms consistent with ameba (figure, D). Indirect immunofluorescence and PCR was positive for Balamuthia mandrillaris. About 200 cases of Balamuthia infection have been reported worldwide, and it has a very high mortality rate of 95%.1
Source: Neurology - Category: Neurology Authors: Tags: MRI, Abscess, Encephalitis, Parasitic infections, All Epilepsy/Seizures RESIDENT AND FELLOW SECTION Source Type: research