S. Gopi, Bhagya Rekha K
BACKGROUND Single small enhancing computed tomography lesion is a worldwide problem, especially in tropical countries endemic for cysticercosis. It is a clinico-radiological entity & is the most common radiological abnormality seen in patients with acute onset seizures in India. MATERIALS AND METHODS This study included 93 patients who attended the Neurology OPD in King George Hospital, Visakhapatnam, between February 2012 and October 2013 with new onset seizures and having a single small enhancing lesion in the brain on imaging <20 mm size. Imaging of the brain was done in all patients which included a computed tomography (CT) brain with contrast or magnetic resonance imaging (MRI) brain with contrast. The characteristics of the lesions were noted in detail. RESULTS Of the 93 patients, 49 (52.68%) were males and 44.37 patients (39.78%) were in the age group of 11-20. Partial seizures with or without secondary generalization was the commonest type of seizure in 70 (75.3%) patients. 83 (89.24%) patients were diagnosed to have either definite or probable Neurocysticercosis, whereas 9 patients were diagnosed to have tuberculoma based on the clinical and imaging findings. Mean size of lesion was 10.69 mm ± 3.07. 53 (56.98%) patients had a lesion larger than 10 mm. The 9 tuberculomas had a mean size of 15 mm ± 3.47. 8 out of 9 tuberculomas were larger than 10 mm. 7 (77.7%) of the 9 tuberculomas and the probable metastasis were surrounded by moderate perilesional oedema. T2 hypointensity on MRI was seen in 6 (66.6%) tuberculomas. Thick, irregular wall was present surrounding all tuberculomas. In the 82 patients who are followed up for the subsequent visits, 63 (76.82%) patients had no recurrence of seizures during the follow up period of 3 months. 19 (23.17%) patients reported recurrence of seizure. 12 (63.15%) patients had first recurrence of seizure in the first month. CONCLUSION Majority of the SSECTL are NCC & tuberculomas. Majority of the NCC are <10 mm in size with minimal perilesional oedema whereas majority of tuberculomas >10 mm with significant perilesional oedema and T2 central hypointensity on MRI. Both NCC and Tuberculomas were common in parietal lobes. The recurrence of seizures is less common in the patients with SSECTL, especially after starting AED.
