#Its Time 82 y/o male came with altered mental status and acute renal failure, PMH includes atrial fibrillation, type 2 DM, CT scan of the head and MRI of the brain revealed multiple lesions located in the left cerebellum, in bilateral frontal lobe, and in the inferior parietal lobe on the left. MRI attached. What would you advice?

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Yes agree with MRI report multiple focal lesions in frontal lobes and cerebellum Are likely tubercular

Thanx dr Pushkar ji Bhomia
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Multiple ring enhancing lesion in an 82 yr old Male with back ground history of DM with acute kidney injury. DD - Mets / TB / lymphoma / Toxoplasmosis/ abscess

Focal lesions in frontal lobes and cerebellum. * Tubercular Needs further investigation and evaluation to conclude diagnosis.

Thanks Dr Pushkar Bhomia
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With Age, Dm, and acute renal failure, this are sign of immunological compromise HIV test needed as well This may may be CNS CRYPOTOCOCCUS. TOXOPLASMOSIS should be ruled out too Differentia may be PML, or t Other degenerative brain disease like dementia

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Agree with Dr.Pushkrji. Seems to be Senile degeneration follwing DM.

Tnx sir
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Multiple focal lesions left cerebellum bilateral frontal lobe inferior pareital investigate core biopsy HP CBC ESR CRP Mt xray chest r/0 tuberculosis

Senile degeneration Multiple organ disease Evaluation is required for diagnosis

MULTIPLE RING ENHANCING LESIONS. HISTOPLASMOSIS TUBERCULOMA METASTATIC LESIONS DO OTHER INVESTIGATIONS TREAT CONSERVATIVELY

Focal lesion in frontal lobes and cerebellum ? Tuberculoma D/d toxoplasmosis Cryptococcal infection

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