A 27-Year-Old Female with Multiple Intracranial Lesions (original) (raw)

Ring-Enhancing Lesions in the Brain: A Diagnostic Dilemma

Iranian Journal of Child Neurology, 2014

The most common radiological abnormality seen in young Indian patients with epilepsy is single small enhancing (ring/disc) computed tomographic (CT) lesions. The two most common differential diagnosis of this lesion in clinical practice include neurocysticercosis (NCC) and tuberculomas. They have similar clinical and neuroimaging features. Few researchers believe that in poor and developing countries (where both tuberculosis and NCC are common) that it is difficult to differentiate between tuberculomas and a single cysticercal granulomas. We report a case of a 6-year-old female patient who presented with complex partial seizures. The patient’s neuroimaging showed a single ring-enhancing lesion in the brain that was not differentiated between NCC and Tuberculoma. Finally, Magnetic resonance spectroscopy (MRS) was suggestive of tuberculoma that was successfully treated with antituberculosis therapy. This report highlights diagnostic difficulties with conventional investigations in sin...

Multiple ring-enhancing lesions: diagnostic dilemma between neurocysticercosis and tuberculoma

BMJ case reports, 2014

Multiple ring-enhancing lesions in the brain often raise many questions about the true diagnosis. The aetiologies are many neoplastic, infectious, vascular, inflammatory and demyelinating conditions and also depend on the geographical location of the patient. The two important causes of multiple ring-enhancing lesions in the cranium are multiple neurocysticercosis and multiple tuberculomas in developing countries like India. This case report illustrates how multiple ring-enhancing lesions cause a diagnostic dilemma between neurocysticercosis and tuberculoma. A young girl with a typical presentation of neurocysticercosis finally turned out to be a case of tuberculoma. A high index of suspicion is required in appropriate clinical settings to have best clinical outcome.

MRI findings of intracranial tuberculomas

Clinical Imaging, 2008

Purpose: Tuberculosis involvement of the central nervous system continues to represent a serious problem, particularly in developing countries. The aim of this study was to characterize the magnetic resonance imaging (MRI) findings of intracranial tuberculoma, a form of neurotuberculosis. Methods: We retrospectively reviewed the data of 27 patients with intracranial tuberculomas. These consisted of 17 women and 10 men with a mean age of 26 years (14-51). MRI was performed on all patients. Results: A total of 64 tuberculomas were found in these patients, of which 41 were distributed in the cerebral hemispheres, 17 in the cerebellar hemispheres, and 6 in the brainstem. Accompanied meningitis was detected in three patients, hydrocephalus in five patients, and hydrocephalus with meningitis in one patient. Conclusion: MRI makes a significant contribution to diagnosis of intracranial tuberculomas and can objectively determine accompanying abnormalities.

Computed Tomography (CT) Scan; Ring Enhancing Lesions on Brain

2015

7 ORIGINAL PROF-2613 ABSTRACT… Ring enhancing lesions are a common neurological problem seen in either gender and in all age groups. Objectives: To determine the clinical presentations and etiological factors in patients with ring enhancing lesion on CT scan brain. Design: Case series study. Period: One year. Setting: Department of medicine, Liaquat University Hospital, Hyderabad. Patients and methods: Subjects of either sex ≥12 years of age, presented with seizures, fever, focal neurological signs and deficit, headache, weight loss and vomiting and had single or multiple ring enhancing lesions on computed tomography (contrast CT brain film) were enrolled and entered in the study. CT scan brain was advised to evaluate any identified lesion and then certain specific biochemical tests were also advised to detect the particular existence etiological factor. The data was analyzed in SPSS 16 and the frequency and percentage was calculated. Results: During one year study period, total 50 ...

Presentation, diagnosis, and treatment of a cerebellar tuberculoma: illustrative case

Journal of Neurosurgery: Case Lessons, 2021

BACKGROUND Central nervous system (CNS) tuberculomas are a feared complication of tuberculosis (TB) infection. These lesions can present in varying manners and are associated with significant morbidity and mortality. Prompt diagnosis and treatment of the lesion and the underlying infection are critical in the care of these patients. The authors presented a case of a 45-year-old Yemeni immigrant presenting with a 3-month history of severe right temporo-occipital headaches with photophobia and night sweats. Imaging showed a rim-enhancing lesion in the right cerebellar hemisphere. OBSERVATIONS Laboratory tests were unremarkable and within normal limits. QuantiFERON testing was negative, ruling out latent TB infection. The patient received a suboccipital craniotomy, and resection of the cerebellar lesion showed caseating granuloma formation, which was positive for acid-fast bacilli and Fite stain. LESSONS CNS tuberculomas are an important differential to consider in patients with a hist...

Cerebral ring enhancing lesion with diffusion restriction in a South American patient

Neurologia i neurochirurgia polska

The differential diagnosis of cerebral ring enhancing lesions is usually challenging and involves the use of multiple paraclinical tools such as central nervous system (CNS) imaging and cerebrospinal fluid (CSF) studies [1,2]. These lesions can be the manifestation of a variety of pathologies, including infection, primary or secondary neoplastic processes and demyelinating diseases, amongst others. By using conventional magnetic resonance imaging (MRI), an accurate diagnosis of ring enhancing lesions is often difficult. Therefore, the use of novel imaging techniques plays a crucial role in fully characterizing and identifying the underlying pathology of such ring enhancing lesions. A 23-year-old man from the south of Chile was admitted to our Department of Neurology in Santiago, with a history of 2 weeks of multiple self-limiting episodes of involuntary clonic movements of his right face and arm, and one single episode of generalized tonic-clonic seizure. On admission, his vital signs and general examination were unremarkable. Initial neurological examination revealed mild right hemiparesis (MCR score 4) with symmetrical tendon reflexes and an ipsilateral up-going plantar reflex. Cranial nerves and sensory function were normal. Complete blood count, erythrocyte sedimentation rate and C-reactive protein were normal, together with negative antibody testing for HIV, Hepatitis B and C, and VDRL. CSF analysis showed 4.8 leukocytes per microliter, protein of 0.27 g/L, normal glucose levels, and a negative Gram stain and culture. The brain MRI showed one cortico-subcortical lesion in the left precentral frontal region (Fig. 1), mildly hyperintense to CSF on T1-weighted image, hyperintense on T2-weighted image and fluid-attenuated inversion recovery (FLAIR) image,

Concurrent multiple intracranial and intramedullary conus tuberculoma: A rare case report

Asian Journal of Neurosurgery, 2014

extremities for 2 weeks and diminution of vision in left eye since 10 days. Examination revealed spastic paraparesis with muscle strength of 2/5 in both lower extremities, impaired sensations below the L1 level, and exaggerated deep tendon reflexes. The magnetic resonance imaging (MRI) of dorso-lumbar spine showed an iso-intense fusiform dilatation of the spinal cord, at the level of conus in T1 and T2-weighted images showed heterogenous hyperintensity at the conus level with one granulamatous lesion at L1 level [Figure 1]. On administration of Gadolinium (Gd)-diethylene triamine pentaacetic acid (DTPA) contrast, the two lesions demonstrated at D12 and L1 level with ring enhancement at the periphery (target sign) [Figure 2]. There was no abnormality in the vertebral bodies or the paraspinal soft-tissues. This lesion, due to its characteristic location, size and classical enhancement was thought to be typical of a tuberculoma. The patient showed negative for HIV, but his chest X-ray revealed randomly distributed miliary nodules in both lung fields, which was highly suggestive of miliary pulmonary tuberculosis. The

A Case Review of Intracranial Tuberculoma in an Immune- Competent Young Nigerian Woman

2020

Intracranial tuberculomas are a rare but well-recognized complication of Tuberculosis. It is associated with high disease burden and mortality. The diagnosis of intracranial Tuberculoma remains a challenge in low-income countries and requires a high index of suspicion. We report a case of rare intracranial Tuberculoma in a young Nigerian woman. She presented with focal seizure, crawling sensation and rotatory movement of the left hand. She also had a history of cough and weight loss over three months. The main finding on clinical examination were features of cerebellar dysfunction on the left side. She had a brain CT scan, which showed multiple ring-enhancing hyperdense mass lesion in Right parietal lobe 8.6x6.6mm. The lesion had extensive peri-lesionaloedema with compression of the ipsilateral lateral ventricle, and a shift of parietal lobe to the Right of the midline. There is also an ill-defined isodense lesion in the left cerebellar hemisphere with peripheral ring enhancement on...