Single enhancing computerized tomography-detected lesion in immunocompetent patients

Area of Science:

• Neurology
• Radiology
• Infectious Diseases

Background:

• Single enhancing brain lesions on CT scans are common in acute-onset seizures, particularly in developing countries.
• These lesions are often attributed to neoplasms or tuberculoma in developed nations, but neurocysticercosis (NCC) is frequently the underlying cause.
• Differentiating between NCC and tuberculoma can be challenging due to overlapping clinical and imaging features.

Purpose of the Study:

• To investigate the etiology and diagnostic criteria for single enhancing brain lesions.
• To evaluate the natural course and management of these lesions, particularly in the context of neurocysticercosis.

Main Methods:

• Review of clinical and radiological findings in patients with single enhancing brain lesions.
• Histopathological correlation where available.
• Analysis of lesion resolution patterns on serial CT scans.

Main Results:

• Neurocysticercosis (NCC) is the most probable cause of single enhancing lesions (<20 mm, minimal edema) in patients with seizures and normal neurological status.
• Lesions often resolve spontaneously, either disappearing or becoming calcified, supporting an NCC diagnosis.
• Tuberculoma is the second most common cause, presenting similar features, making differentiation difficult in endemic areas.

Conclusions:

• Single enhancing brain lesions in seizure patients are frequently due to NCC, especially when they resolve spontaneously.
• Antiepileptic therapy is the mainstay of treatment; anticysticercal drugs have uncertain benefit.
• Brain biopsy is rarely needed, reserved for refractory cases or diagnostic uncertainty.