Image 19 A patient presents with delusions, depression, lethargy and intermittent imbalance increasing over the previous 10 months and a recent intermittent fever. He came to Canada from the Congo as a refugee 22 months earlier. His MRI reveals the changes noted on the left. (compared to a normal MRI) The diagnosis is:
Axial FLAIR (patient)	Axial FLAIR (normal)

Axial FSE T2 (patient)	Axial FSE T2  (normal)

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Image 19: African sleeping sickness encephalitis caused by Trypanosoma brucei gambiense.  Serum IgG and IgM levels were sky high as was the CSF lymphocyte count. Trypanosoma were found in blood and CSF and the T. brucei PCR was positive in both.{National Reference Centre Parasitology (NRCP), Montreal).  Trypanosoma brucei serology by the CATT test was positive at the NRCP. Morula cells of Mott were seen in the CSF (see image 10) He also had Winterbottom's sign.