Atypical clinical and imaging manifestation in neurocysticercosis

Dayananda, L; Kesavadas, Chandrasekharan; Neelima, R; Radhakrishnan, Venkatraman

doi:10.4103/0972-2327.91955

Cited by 6 publications

(4 citation statements)

References 7 publications

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“… 15 In the present case, the mean standardized rCBV was 1.11, consistent with infection. Although this spatially averaged value is consistent with infection according to the threshold determined by Floriano et al, 16 this threshold of <1.3 overlaps with standardized rCBV values reported for different grades of gliomas. This makes it difficult to distinguish infection from primary brain tumor based on averaged rCBV values.…”

Section: Discussionsupporting

confidence: 89%

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Magnetic resonance imaging–derived relative cerebral blood volume characteristics in a case of pathologically confirmed neurocysticercosis: illustrative case

Botros,

Polinger-Hyman,

Beck

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND Neurocysticercosis (NCC) is a parasitic infection of the brain caused by ingesting water or food contaminated with tapeworm eggs. When it presents as a solitary mass, differentiation from a primary brain tumor on imaging can be difficult. Magnetic resonance imaging (MRI)-derived relative cerebral blood volume (rCBV) is a newer imaging technique used to identify areas of neovascularization in tumors, which may advance the differential diagnosis. OBSERVATIONS A 25-year-old male presented after a seizure. Computed tomography (CT) and MRI demonstrated a partially enhancing lesion with microcalcifications and vasogenic edema. Follow-up rCBV assessment demonstrated mild hyperperfusion and/or small vessels at the lesional margins consistent with either an intermediate grade glioma or infection. Given the radiological equipoise, surgical accessibility, and differential diagnosis including primary neoplasm, metastatic disease, NCC, and abscess, resection was pursued. The calcified mass was excised en bloc and was confirmed as larval-stage NCC. LESSONS CT or MRI may not always provide sufficient information to distinguish NCC from brain tumors. Although reports have suggested that rCBV may aid in identifying NCC, here the authors describe a case of pathologically confirmed NCC in which preoperative, qualitative, standardized rCBV findings raised concern for a primary neoplasm. This case documents the first standardized rCBV values reported in a pathologically confirmed case of NCC in the United States.

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Section: Discussionsupporting

confidence: 89%

“…A conflicting 2011 report described a case of NCC in which a twofold increase in rCBV in perfusion MRI was demonstrated in comparison to the patient’s contralateral side. 16 As demonstrated in previous reports and the present case, distinguishing infection from primary neoplasm based on rCBV alone remains a challenge.…”

Section: Discussionmentioning

confidence: 54%

Magnetic resonance imaging–derived relative cerebral blood volume characteristics in a case of pathologically confirmed neurocysticercosis: illustrative case

Botros,

Polinger-Hyman,

Beck

et al. 2023

Journal of Neurosurgery: Case Lessons

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“…These lesions are commonly reported in neurotuberculosis. [8910] These lesions have also been described in nocardiosis,[11] cranial blastomycosis,[12] and NCC[13] as isolated case reports. Conglomerate RELs are best seen in MRI due to its better soft-tissue resolution and multiplanar capabilities.…”

Section: Introductionmentioning

confidence: 99%

Conglomerate ring-enhancing lesions are common in solitary neurocysticercosis and do not always suggest neurotuberculosis

Garg

Kaur

Sebastian

et al. 2019

Ann Indian Acad Neurol

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Background and Purpose:Differentiating between neurocysticercosis (NCC) and neurotuberculosis has serious therapeutic implications and this distinction relies heavily on neuroimaging. Few case reports discuss the conglomeration of ring-enhancing lesions (RELs) in patients with solitary NCC. The aim of our study is to describe the imaging findings of conglomerate RELs in a cohort of patients with solitary NCC, emphasizing the frequency of conglomeration.Materials and Methods:This retrospective study included 100 patients with solitary NCC. Two neuroradiologists analyzed contrast-enhanced computed tomography (CT) images regarding morphology, enhancement pattern, location, number of lesions, and degree of perilesional edema. The solitary lesions were classified as solitary discrete RELs (SD-RELs) when a well-defined lesion was seen and solitary conglomerate RELs (SC-RELs) when two or more ring lesions or ring/rings plus disc lesions were present contiguously. Follow-up CT scans were evaluated for the resolution of lesions and surrounding edema.Results:Out of 100 patients, 42 were SD-RELs and 58 were SC-RELs. No statistically significant difference was found between both groups in terms of age of presentation, clinical presentation, lesion size and location, and degree of perilesional edema. Larger lesions (>10 mm) were more likely to show scolex and were associated with greater degree of edema in both subgroups. During follow-up, 13 patients had new lesions (SD-RELs-5, SC-RELs-8). In SD-RELs, follow-up lesions were in the same location in four patients and new location in one; and in SC-RELs, lesions were in the same location in seven and in new location in one case.Conclusion:Conglomeration of RELs is a common finding in patients with solitary NCC.

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“…In patients with single parenchymal lesions, the diagnosis is challenging, as morphology on neuroimaging can be inconclusive and serology is commonly negative [ 4 ]. In endemic regions, neurocysticercosis may be confounded with other infections that affect the brain parenchyma such as tuberculosis, owing to similar radiographic appearance [ 5 ]. Albendazole is the treatment of choice, which should be administered with corticosteroids to reduce the inflammation associated with dying organisms [ 6 , 7 ].…”

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confidence: 99%

Solitary Brain Mass in a Patient with Seizures: An Unexpected Infectious Etiology

2018

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Neurocysticercosis is a parasitosis caused by the larval stage of the pork tapeworm Taenia solium. The diagnosis is challenging as morphology on neuroimaging can be inconclusive and serology is frequently negative. We describe the case of a 24-year old Hispanic man who presented with seizures and loss of consciousness. Magnetic resonance imaging (MRI) showed a cystic mass in right frontal lobe. Work-up that included body computed tomography (CT) scan and Western blot serology for Echinococcus and cysticercosis was unrevealing. He underwent craniotomy with resection of the mass. Histopathology showed fragments of Taenia solium. He was treated with albendazole for 14 days. No further seizures were noted at 6-month follow-up.

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Atypical clinical and imaging manifestation in neurocysticercosis

Cited by 6 publications

References 7 publications

Magnetic resonance imaging–derived relative cerebral blood volume characteristics in a case of pathologically confirmed neurocysticercosis: illustrative case

Magnetic resonance imaging–derived relative cerebral blood volume characteristics in a case of pathologically confirmed neurocysticercosis: illustrative case

Conglomerate ring-enhancing lesions are common in solitary neurocysticercosis and do not always suggest neurotuberculosis

Solitary Brain Mass in a Patient with Seizures: An Unexpected Infectious Etiology

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