Ring-enhancing lesions in the brain: a diagnostic dilemma

The most common radiological abnormality seen in young Indian patients with epilepsy is single small enhancing (ring/disc) computed tomographic (CT) lesions. The two most common differential diagnosis of this lesion in clinical practice include neurocysticercosis (NCC) and tuberculomas. They have similar clinical and neuroimaging features. Few researchers believe that in poor and developing countries (where both tuberculosis and NCC are common) that it is difficult to differentiate between tuberculomas and a single cysticercal granulomas. We report a case of a 6-year-old female patient who presented with complex partial seizures. The patient's neuroimaging showed a single ring-enhancing lesion in the brain that was not differentiated between NCC and Tuberculoma. Finally, Magnetic resonance spectroscopy (MRS) was suggestive of tuberculoma that was successfully treated with antituberculosis therapy. This report highlights diagnostic difficulties with conventional investigations in single ring enhancing lesions in the brain and role of MRS in a diagnosis.MRS is helpful in differentiating these two conditions.