Clinical spectrum of small ring enhancing lesions on computerised tomography in Jammu region
Journal Title: MedPulse -International Medical Journal - Year 2017, Vol 4, Issue 4
Abstract
Background: Single small enhancing computed tomography lesions may occur in several infections and neoplastic diseases of the central nervous system and are most common radiological abnormality seen in patients with focal seizures in India and many other developing countries. Similar CT documented lesions have also been reported in the developed world where these lesions are often considered to be caused by neoplasm or tuberculoma. Histopathological studies in India revealed that neurocysticercosis (NCC) is the most likely cause of these lesions provided they fulfil a rigid set of clinical and radiological criteria. Aims and objectives: To study the clinical and radiological spectrum of small ring enhancing CT lesions in Jammu region. Materials and methods: in the present study total 100 cases of multiple or single small enhancing CT lesions with no neurologic deficit on clinical examination were selected. A detailed sociodemographic and seizure history was elicited and a complete physical and neurologic examination was performed in all patients and recorded on a prestructured proforma. A complete clinical assessment was done. Haemogram, Erythrocyte sedimentation rate (ESR), Mantoux test, Chest radiography and Cysticercus serology (using ELISA) were done in all cases. The follow up contrast enhanced CT head scan was obtained. All CT scans were assessed by a Radiologist. The site and size of the lesion and the presence of edema were recorded. The collected data was entered in Microsoft excel and was presented by using appropriate table and graphs. Results: It was observed that majority of the patients in the study were young and were in the age group of 21 to 50 years. In our present study there were 58 males and 42 females. The most common presenting symptom reported by patients with small ring enhancing CT lesions was focal seizures (50%) followed by generalized seizures (35%). In the present study the CT scan findings revealed scolex in only 17 patients, perilesional edema in 87 patients, hydrocephalus in 6 patients, coalescing lesions in 5 patients, non-coalescing lesions in 95 patients, solitary lesions in 56 patients, multiple lesions were seen in 44 patients. On CT scan thin wall was seen in 82 patients, thick wall in 13 patients, irregular wall seen in 5 patients and calcification was seen in 2 patients. Most commonly the lesions were located in the parietal lobe (23%) followed by occipital lobe (13%), temporal Lobe (12%), parietotemporal lobe (12%). The NCC was the most common lesion among these small ring enhancing CT lesions and was seen in 80 patients out of 100 patients studied. Conclusion: On the basis of above results and discussion we conclude that majority of the small ring enhancing lesion were neurocystecercosis. Focal seizure in younger age was the most common presentation. Thin walled Solitary lesion with Peilesional edema in the partial region was the most common CT finding.
Authors and Affiliations
Haroon Salaria, Kulbhushan Gupta
Keywords
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