MRI imaging revealed widespread hemispheric white matter as well
as deep gray matter lesions and brain stem T2-signal prolongation
(Fig. 1A,B). Analysis of CSF showed a predominantly lymphocytic
pleocytosis (261 cells/μl, 89,5% lymphocytes), elevated total protein
(138 mg/dl) and intrathecal immunoglobulin productionwith predominantly
class IgM antibodies (detailed data on initial CSF examination
are shown in Table 1; follow-up data are depicted in Fig. 1G). The serology
for T. bruceiwas positive in serumand CSF. A brain biopsy, primarily
performed to rule out lymphoma or gliomatosis cerebri, showed typical
features of HAT encephalitis (Fig. 1E). PCR for T. brucei was positive in
the brain biopsy, but negative in CSF and blood. For details of PCRAssay
used see Reference [2]. Live motile trypanosomes were detected
in direct microscopy of CSF prepared in cytospin centrifugation. Thin
films of CSF were prepared and stained for identification of trypanosomes
(Fig. 1F). Results of parasitological examinations are summarized
in