Magnetic resonance spectroscopy in ring enhancing lesions.

Area of Science:

• Neurology
• Radiology
• Infectious Diseases

Background:

• Ring-enhancing lesions on brain imaging can present a diagnostic challenge.
• Neurocysticercosis is a common differential diagnosis for such lesions, especially in endemic areas.
• Treatment failure for presumed neurocysticercosis necessitates further diagnostic investigation.

Observation:

• A 4-year-old girl presented with ring-enhancing lesions on computed tomography (CT).
• Initial diagnosis was neurocysticercosis, but the patient did not respond to cysticidal therapy.
• Magnetic resonance spectroscopy (MRS) was performed to further evaluate the lesions.

Findings:

• MRS revealed characteristic lipid peaks, strongly suggesting intracranial tuberculoma.
• The patient was treated with antituberculosis therapy based on the MRS findings.
• The lesions showed successful resolution following antituberculosis treatment.

Implications:

• This case underscores the utility of MRS in differentiating causes of ring-enhancing brain lesions.
• MRS can guide appropriate therapy when initial diagnoses are uncertain or treatment is ineffective.
• Early and accurate diagnosis of intracranial tuberculoma is vital for effective management and improved patient outcomes.