Neurocysticercosis - solitary

Case contributed by Dr Ng Thanh Van Anh

Presentation

Headache and new-onset seizure.

Patient Data

Age: 40 years
Gender: Female
MRI

MRI shows a solitary well-defined lesion, measured 11x12 mm involved the grey-white matter junction on the left parietal lobe with thin hypointense rim and hypointense central dot on T2*W. Post-contrast, it shows ring enhancement with a central dot enhancement. Moderate surrounding vasogenic edema in the left parietal lobe. 

Thorax CT showed no mass or nodule. The patient went on surgery to remove the lesion. 

Histology: Features are consistent with neurocysticercosis. 

Case Discussion

MRI findings are the enhancement of wall and scolex with surrounding edema which is consistent with the colloidal stage of neurocysticercosis. This case shows the cyst with dot sign, which is characteristic of the colloidal stage of neurocysticercosis.

Isolated neurocysticercosis can be atypical and not always easy to make a correct diagnosis because typical findings for neurocysticercosis are multiple lesions at multiple stages.

Differentials for an isolated lesion are tuberculoma or solitary metastasis. Hence the reason why this patient underwent a thorax CT to look for a primary tumor or pulmonary tuberculosis. 

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