Neurocysticercosis (NCC) vs Central Nervous System (CNS) Tuberculoma in Children—Dilemma over Clinico-Radiological Diagnosis?

Abstract

Background: Neurocysticercosis (NCC) and central nervous system (CNS) tuberculomas often overlap in clinical presentation and imaging. Though the aetio-pathology entirely differs in both the scenarios but there is great confusion in their clinicoradiological evaluation as the findings and appearances are similar in many ways. The stress should be laid out over the salient features of each entity in the background of their presentation. The study was conducted to highlight the differentiation of the clinico-radiological findings in both the entities. Material and Methods: Ten patients between 5 -15 years (mean age 10.4 years) with complaints of headache and with or without seizures had undergone MRI alone or with CT examinations. Basic sequences of T1W, T2W, T2W FLAIR and T1W contrast studies were carried out in all the cases. CT was carried out in only three cases and contrast was given in two cases. Results: Eight patients were having ring enhancing lesions in post contrast studies in MRI and two had only cystic lesions ranging from 1 -3 cm in diameter. Conclusion: Seven cases having tuberculomas were confirmed by both the modalities with one case inconclusive. Two cases were diagnosed as neurocysticercosis as per the results. The reasonable achievable target was the goal to differentiate between NCC and tuberculomas in the brain and it was achieved. Contrast MRI and spectroscopy brought out many findings for the distinct features in many cases.

Multiple Cystic Brain Infection: A Diagnostic Dilemma of Neurocysticercosis and Intracranial Tuberculoma - Case report

“…Intracranial tuberculoma may resemble NCC in radio imaging, as they both present as rim-enhancing lesions (10). In this case, a lesion size of less than 2cm and the absence of signs of meningitis are indicators that intracranial tuberculosis is unlikely.…”

Starry sky appearance of tuberculoma

“…In neurocysticercosis, MR spectroscopy shows multiple aminoacid peaks whereas in tuberculoma, it shows lipid peak. 5 MR spectroscopy identified lipid peaks in all the lesions and raised the suspicion of tuberculoma. MR Spectroscopy was used to differentiate single enhancing brain lesions as due to tuberculomas or neurocysticercosis.…”

A Case of Rarest Presentation of CNS Tuberculosis as Disseminated Miliary Tuberculoma Brain

“…Tuberculomas are commonly more than 20 mm in size however in miliary tuberculoma are less than 20 mm in size so di cult to differentiate from Neurocysticercosis on the bases of size. (4) On non contrast CT scan these lesions can easily be missed because of small size. Another important character is that, these lesions have very less perilesional edema as compare to classical tuberculoma which has disproportionate perilesional edma.…”