Neuroimaging: cryptococcal infection in HIV: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Neuroimaging: cryptococcal infection in HIV

Sample item

A patient with HIV and a CD4 count below 50 has headache and confusion with a high CSF opening pressure. MRI shows many small non-enhancing T2-hyperintense cystic lesions in the basal ganglia bilaterally. What is the most likely diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Cryptococcal infection with gelatinous pseudocysts

Cryptococcus spreads along perivascular spaces and fills them with gelatinous mucoid material, creating soap-bubble lesions in the basal ganglia with little inflammation or enhancement. Raised intracranial pressure is a typical complication.

Option by option

  • A. CMV ventriculitis

    CMV ventriculitis shows ependymal enhancement lining the ventricles.

  • B. Cerebral toxoplasmosis

    Toxoplasmosis forms ring or nodular enhancing lesions with oedema.

  • C. Primary CNS lymphoma

    Lymphoma is a solid, homogeneously enhancing periventricular mass.

  • D. Cryptococcal infection with gelatinous pseudocysts (correct)

    Correct. Non-enhancing perivascular cysts in the basal ganglia with raised pressure suggest cryptococcosis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is D, Cryptococcal infection with gelatinous pseudocysts. Cryptococcus spreads along perivascular spaces and fills them with gelatinous mucoid material, creating soap-bubble lesions in the basal ganglia with little inflammation or enhancement.

Why is "CMV ventriculitis" not the answer?

CMV ventriculitis shows ependymal enhancement lining the ventricles.

Why is "Cerebral toxoplasmosis" not the answer?

Toxoplasmosis forms ring or nodular enhancing lesions with oedema.

Why is "Primary CNS lymphoma" not the answer?

Lymphoma is a solid, homogeneously enhancing periventricular mass.

What concept does this question test?

It tests Neuroimaging: cryptococcal infection in HIV in Radiology. Raised intracranial pressure is a typical complication.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neuroimaging: cryptococcal infection in HIV?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.