TUBERCULOMA VERSUS NEUROCYSTICERCOSIS-BRAIN

TUBERCULOMA VERSUS NEUROCYSTICERCOSIS BRAIN

Solitary granulomatous lesions are common causes of seizures and headache in India and elsewhere. The two most common causes are: 1. Tuberculoma (caused by Mycobacterium tuberculosis), 2. Neurocysticercosis-NCC (caused by tapeworm, Taenia solium).

 Treatment involves 1. Use of antiepileptic drugs for seizure control, 2. Specific anti-infective treatment for for TB or NCC. Anti-tuberculous treatment is long and may be needed for 18 months or longer. For tapeworm infection (NCC), 1-2 week treatment may be enough.

 Appropriate treatment depends on confirmation of diagnosis. The gold standard for confirming the diagnosis is biopsy of the lesion, which requires surgery in brain. Therefore, practically diagnosis depends on MRI and CT scan features.

 MRI features favoring a diagnosis of tuberculoma are: 1. Size> 2 cm, 2. Severe perilesional edema, 3. Conglomerate lesions. Presence of focal neurological deficits also favor a diagnosis of tuberculoma. 

 However, these findings are not sacrosanct and there could be exceptions. In a recent case, I saw a patient with conglomerate lesions on MRI with significant edema, which was highly suggestive of tuberculoma. After discussing in detail with the patient, we decided to start only anti-parasitic treatment with albendazole. MRI brain scan was repeated after six months, which showed significant reduction in the size of lesion. Perilesional edema had also reduced. 
 PRE-TREATMENT (conglomerate lesion)

 POST-TREATMENT (Lesion size has reduced)

 PRE-TREATMENT (Large perilesional edema)

 POST-TREATMENT (Edema has significantly reduced)

 PRE-TREATMENT (Large lesion)

POST-TREATMENT (Lesion size has reduced)

CONCLUSION: MRI Brain findings in isolation may be insufficient to differentiate between tuberculoma and neurocysticercosis. Clinical findings and other features (involvement of extra-CNS sites, CSF analysis, etc) should also be considered before any treatment is offered.

DR SUDHIR KUMAR MD DM
Senior Consultant Neurologist
Apollo Hospitals, Hyderabad
04023607777
drsudhirkumar@yahoo.com
www.facebook.com/bestneurologist

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