What are the differentiating points between tuberculoma and NCC?
1. The vesicular stage of NCC does not produce any immunological response and is characterized by nonenhancing cystic lesions. 2. Conglomerate lesions are unusual in NCC and are commonly seen in TB. 3.Peripheral T2 hypointense ring with increased perfusion is also an unusual MRI finding in NCC. 4.NCC occasionally presents with scolex which appears as enhancing eccentric mural nodule.
Multiple ring enhancing lesions which are isointense to gray matter on T1, hypointense on T2 and FLAIR with surrounding vasogenic edema seen involving bilateral precentral gyri, bilateral centrum semiovale and corona radiate, left angular gyrus, bilateral middle frontal gyri, right superior frontal gyrus, left inferior frontal gyrus, left superior and middle temporal gyrus, inferior cerebral peduncle and mid brain.
No blooming on SWI and no hyperintensity on DWI or ADC is noted.
Imaging features and clinical profile of the patient are suggestive of multiple tubercular granulomas.