Single-enhancing CT lesions in Indian patients with seizures: a review.
Single enhancing CT lesions are the commonest radiological abnormality in Indian patients with new-onset partial seizures. In few patients the lesions may be 'tuberculoma' (especially in presence of evidence of tuberculosis elsewhere). However, histopathological studies have proved that neurocysticercosis is the most frequent cause for these lesions. Acute inflammation in and around the cerebral lesions of cysticercosis manifests as acute seizure disorder. These cysticercal granulomas represent 'colloidal' and 'nodular-granular' stages of Escobar's pathological classification of natural evolution of a parenchymal cysticercus cyst. In 8-12 weeks time majority of these lesions spontaneously disappear, few may calcify. As albendazole therapy is of controversial value, these patients, possibly, need to be treated only with antiepileptic drugs. Associated seizure disorder is also benign in nature and remit in majority within 6-8 months, recurrences are usually infrequent. Antiepileptic drug may be withdrawn once follow-up CT scan shows resolution of the lesion. If seizures recur after resolution of the lesion, CT lesion persists or CT lesion calcified, a long-term (2-3 years) antiepileptic therapy may be required. The single enhancing CT lesions which persist despite anticysticercal or antituberculous therapy may need histopathological evaluation to establish the correct diagnosis.
Kumar Garg
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Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
Kumar Singh
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Misra
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D000465:Algorithms; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood; D000909:Antibodies, Helminth / Q000097:blood / Q000276:immunology; D000927:Anticonvulsants / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging* / Q000469:parasitology; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging*; D002648:Child; D003552:Cysticercus / Q000254:growth & development / Q000276:immunology / Q000302:isolation & purification; D003937:Diagnosis, Differential; D004828:Epilepsies, Partial / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D006099:Granuloma / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007194:India / Q000453:epidemiology; D007814:Larva; D008279:Magnetic Resonance Imaging; D009169:Mycobacterium tuberculosis / Q000276:immunology; D020019:Neurocysticercosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology; D011379:Prognosis; D012008:Recurrence; D012640:Seizures / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016862:Tuberculoma, Intracranial / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology
D000871:Anthelmintics; D000907:Antibodies, Bacterial; D000909:Antibodies, Helminth; D000927:Anticonvulsants; D000995:Antitubercular Agents