Single, small, enhancing lesions that often resolve spontaneously are frequent findings on CTs of Indian patients with seizures. Based on ELISA and biopsy data, the majority of these lesions are probably cysticercosis. To determine if these patients should be treated with albendazole, we performed a double-blind, randomized, placebo-controlled study involving 75 patients with seizures and the appropriate CT abnormality without neurologic abnormality on examination. Patients were randomized to albendazole (15 mg/kg/d) and placebo for 1 week, and we obtained serial CTs at the end of 1 week, 1 month, and 3 months. All patients completed a 3-month follow-up and none had systemic evidence of tuberculosis or cysticercosis. The lesions varied in size from 3 mm to 2.1 cm, with an average size of 1.18 cm. Serum ELISA for cysticercosis was positive in 30 and CSF ELISA was positive in 20 of 45 patients. Forty patients received albendazole and 35 received placebo. At the end of 3 months, a total of 68 patients showed resolution. Thirty-five of 40 patients who received albendazole showed resolution, as opposed to 33 of 35 patients on placebo. We conclude that albendazole therapy was not beneficial.
A complete necropsy showed multiple acute liver necroses, fibrinous endocarditis, subpleural petechiae, pulmonary oedema and the morphological signs of shock. The neuropathological investigation revealed a typical epidermoid cyst at the base of the brain extending from the interpenduncular fossa to the upper medulla oblongata with a mean diameter of 1 cm. The whole left aspect ofthe pons and the left cerebellopontine angle were covered by the tumour. Both oculomotor nerves, the left trigeminal, facial and the vestibulocochlear nerves as well as both abducent and glossopharyngeal nerves were covered with pearly masses. The tumour lacked calcifications. There was no bone destruction at the base of the skull. The brainstem was slightly displaced to the right.We conclude that in cases with cranial nerve lesions and cerebellar signs or even meningeal signs an epidermoid cyst at the base of the brain should be excluded. As our observations show, routine performance of CT and MRI may fail to reveal the tumour.
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