Is lumbar puncture indicated?

A focal convulsion with a ring-enhancing lesion on neuroimaging is always suspicious for neurocysticercosis, tuberculoma, and toxoplasma. CNS toxoplasmosis is usually seen in immunocompromised patients at the junction of the grey-white junction. Neurocysticercosis (NCC) is usually a solitary lesion and is seen in higher peripheral cortical areas with a scolex inside. Tuberculomas are usually infratentorial at the areas of blood vessels and are often multiple. Thus even though neuroimaging may show ring-enhancing lesions, the classical varieties are often difficult to see and it is often difficult to differentiate between NCC and tuberculoma. In that case, indirect features such as meningitis on CSF, Mantoux test, and Chest X-Ray are required to help in the diagnosis. Thus, a lumbar puncture would be advisable to rule out meningitis. Also, an ophthalmological examination is warranted prior to starting Albendazole as ocular cysticercosis is a contraindication for antihelminthic as it will lead to blindness.