MRI of recurrent isolated cerebral Whipple's disease.

Whipple's disease is a rare systemic bacterial infection, characterized predominantly by gastrointestinal symptoms. Neurological symptoms are frequent in the course of the disease; however, a purely neurological presentation is uncommon. Diagnosis is confirmed with biopsy and polymerase chain reaction studies. Magnetic resonance imaging (MRI) findings vary, most commonly showing increased signal intensity on T2-weighted images. Contrast-enhanced images and diffusion- weighted imaging are useful to demonstrate meningeal enhancement and any accompanying infarcts. Brain biopsy is often performed, and MRI is crucial to guide the biopsy. Cerebral Whipple's disease is a long-lasting infection requiring long-term follow-up of these patients. MRI should be performed to detect any potential recurrence. We present a case of recurrent isolated cerebral Whipple's disease in a 68-year-old man with atypical presentation and MRI findings.