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Case Reports
. 2011 Oct;14(4):295-7.
doi: 10.4103/0972-2327.91955.

Atypical clinical and imaging manifestation in neurocysticercosis

L Dayananda  1 , C Kesavadas, Bejoy Thomas, R Neelima, V V Radhakrishnan
Affiliations
Case Reports

Atypical clinical and imaging manifestation in neurocysticercosis

L Dayananda et al. Ann Indian Acad Neurol. 2011 Oct.

Abstract

A 20-year-old man presented with left-sided headache and seizures of three years duration. Conglomerate ring-enhancing lesions were seen in the first magnetic resonance imaging study. He was initially treated with anticonvulsants for two years. Because the symptoms and the lesions were persisting, antitubercular treatment was added. He was asymptomatic after antitubercular treatment despite persisting lesion. Lesion showed exuberant ring enhancement with increased perfusion. Because the lesion was persisting even after 24 months of antitubercular treatment, excision was considered. Lesionectomy was done and histopathology reported meningoencephalitis secondary to neurocysticercosis. The case report highlights the difficulty in differentiating cysticercosis from tuberculoma in patients from countries where both the conditions are endemic.

Keywords: Chronic meningoencephalitis; magnetic resonance imaging; neurocysticercosis; perfusion magnetic resonance imaging.

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Conflict of interest statement

Conflict of Interest: Nil.

Figures

Figure 1
Figure 1
T2 weighted axial (a) and postcontrast T1 (b) MRI images (dated March 2006) showing conglomerate lesions in right frontal lobe, which shows ring enhancement following gadolinium injection. Corresponding MRI images (c and d) showing images done on December 2008 reveals persisting lesion with decreased center cystic area
Figure 2
Figure 2
Axial T2 and FLAIR images of MRI images taken on April 2009, showing right frontal lobe lesion which is predominately hypointense (a and b). No diffusion restriction is seen (c and d). Exuberant contrast enhancement is seen (e) along with increased rCBV (f). Spectroscopy at TE 135 and TE 30 (g and h) showing decreased NAA peak and increased choline. Lipid peak is also seen
Figure 3
Figure 3
Axial postcontrast T1 weighted MRI image (September 2009) showing persisting lesions (a). Histopathology sections showing degenerated cysticercosis cyst (b) (H&E, ×200)
See this image and copyright information in PMC

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