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Case contributed by Dr Mohammad A. ElBeialy


60 years old female patient with headache and seizures on antiepileptic medications. No significant past history.

Patient Data

Age: 60 years
Gender: Female


  • multiple bilateral supra- and infra-tentorial predominantly extra-axial as well as intra-axial small ring enhancing lesions are seen within the subarachnoid spaces of the cerebral and cerebellar convexities; with the largest in the right posterior high frontal parafalcine region is seen measuring 12 X 8 mm. Those lesions seen within the left sylvian fissure shows typical nodular branching with grape-like or racemose pattern. These lesions are associated with mild focal meningeal enhancement. They show predominantly low T1 and T2 as well as GRE/ SWI signal intensities with no restricted diffusion. They are associated with mild vasogenic brain edema.  
  • Mild supra and infra-tentorial hydrocephalic changes with mild peri-ventricular T2/FLAIR hyperintensity.

CT study shows these lesions as small calcified lesions predominantly within the extra-axial subarachnoid spaces.

Case Discussion

Multiple bilateral supra- and infra-tentorial predominantly extra-axial as well as intra-axial ring enhancing and calcified lesions , consistent with neurocysticercosis (granular / calcified phase) with mild supra- and infra-tentorial hydrocephalic changes.     

The main differential diagnosis is tuberculosis; however it is :

  • parenchymal marginally enhancing cystic lesions with tuberculous basal meningitis. The tuberculoma may show restricted diffusion with T2 hypointense wall.
  • extra-cerebral pulmonary lesions is common association.              
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Case information

rID: 27365
Published: 31st Jan 2014
Last edited: 23rd Feb 2020
Tag: brain
Inclusion in quiz mode: Included

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