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Multiple ring enhancing brain lesions on computed tomography: an Indian perspective.

Ravindra Kumar Garg1, Parthiv Desai, Minakshi Kar

  • 1Department of Neurology, King George's Medical University, Lucknow-226003, India. garg50@yahoo.com

Journal of the Neurological Sciences
|October 20, 2007
PubMed
Summary

Infective pathologies, particularly tuberculosis and neurocysticercosis, are the most frequent causes of multiple enhancing brain lesions in India. Diagnosis can be challenging, with many cases remaining idiopathic despite thorough investigation.

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Area of Science:

  • Neurology
  • Radiology
  • Infectious Diseases

Background:

  • Multiple enhancing computed tomography (CT) brain lesions represent a significant neuroimaging abnormality observed frequently in India.
  • Existing literature indicates a broad spectrum of infective and non-infective conditions can manifest as multiple enhancing brain lesions.

Purpose of the Study:

  • To investigate the diverse etiologies of multiple enhancing brain lesions in a prospective cohort.
  • To evaluate the diagnostic yield of clinical assessment and standard investigations in identifying the cause of these lesions.

Main Methods:

  • A prospective follow-up study involving 110 consecutive patients presenting with two or more enhancing brain lesions on CT.
  • Comprehensive clinical evaluation and a battery of common investigative tests were performed for all participants.

Main Results:

  • Infective pathologies were identified as the predominant cause, with tuberculosis being the most common, followed by neurocysticercosis.
  • Neoplastic diseases, primarily metastatic lung carcinoma, were the leading non-infective etiologies. Some cases involved brain abscesses, Behcet's syndrome, and systemic lupus erythematosus.
  • Etiological diagnosis remained elusive in 45 patients, who received empirical treatment; a subset showed radiological improvement or progression, while most remained stable.

Conclusions:

  • A wide array of infectious and non-infectious diseases can lead to multiple enhancing brain lesions.
  • A systematic approach including clinical evaluation, imaging, and laboratory tests is crucial for diagnosis.
  • Achieving a specific etiological diagnosis presents a significant challenge in a substantial proportion of cases.