13 year old Indian presenting with seizures.
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The study reveals multiple focal and conglomerate peripheral rim enhancing lesions with hypointense center on T2w images and mild to moderate perilesional edema in bilateral cerebellar hemispheres, right frontal, bilateral occipital and left posterior parietal lobes. There is mild mass effect on leftlateral aspects of 4th ventricle. Subtle leptomeningeal enhancement seen at places.
Spectroscopy through the cerebellar lesions show elevated lipid lactate peaks.
The imaging features, particularly in an endemic area, are almost certainly those of tuberculomas, particularly in view of the T2 hypointense centers. The differential diagnosis includes neurocysticercosis, however, points that favor the diagnosis of tuberculoma are:
- no obvious scolex is seen in any of the lesions
- T2 hypointense core
- leptomeningeal enhancement
- presence of conglomerate lesions
- lipid-lactate peak on MRS