Diagnostic Dilemma

Neurocysticercosis or tuberculoma

An 8 years old girl had a right sided focal convulsion 5 months back. MRI brain at that time was suggestive of well defined ring enhancing. T2 hyperintense conglomerate lesions in left high parietal region with surrounding perilesional edema {1.2 x 1cm} suggestive of neurocysticercosis. She was given Albendazole for 28 days and steroids in tapering doses. She was continued on Carbamazepine. She was alright for next 3 months when she again had a focal convulsion. At that time MRI showed same size lesion with no change as compared to previous scan. She had no other complaints and contact with TB was not present. Her CSF was normal, CSF TB PCR was negative, Chest X-Ray and Mantoux test were negative. Her blood cysticercus IgG was negative. She was started on 4 drug AKT in view of persistent granuloma. Currently the child has completed 2 months of ATT and is otherwise asymptomatic.

Is the child having neurocysticercosis or tuberculoma_?
Expert Opinion :
As all of you have seen, that differentiation of tuberculoma and NCC is very difficult. CSF TB PCR is not very reliable due to poor sensitivity and thus negative PCT does not rule out TB. Conglomerate lesions makes one think of TB but again, high parietal lesion makes one suspicious of NCC. There is no clear cut guideline to treat such patients and one may have to go through a detailed history, examination and investigations to decide what is best for the child.
Answer Discussion :
12 years ago
drbharat bansal
12 years ago

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