Eccentric Target Sign: Think Neurotoxoplasmosis

摘要

A 50-year-old woman started a 1-month history of progressive left hemiparesis and headache. Symptoms have progressed to mental deterioration, being necessary orotracheal intubation. A brain magnetic resonance imaging was performed (Figure 1). Eccentric target sign was found and cerebral toxoplasmosis suspected. HIV serologic test confirmed infection. Sulfadiazine, pyrimethamine, leucovorin, and adjunctive corticosteroids were started, with good clinical and radiological response. Eccentric target sign is characterized by a ring-shaped zone of peripheral enhancement with a small eccentric nodule along the wall. Although considered highly suggestive of toxoplasmosis, this sign is seen in less than one-third of cases.