IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Neurocysticercosis

Case contributed by Mohammad A. ElBeialy
Diagnosis almost certain

Presentation

60 years old female patient with headache and seizures on antiepileptic medications. No significant past history.

Patient Data

Age: 60 years
Gender: Female
mri

Findings: 

  • multiple bilateral supra- and infra-tentorial predominantly extra-axial as well as intra-axial small ring enhancing lesions are seen within the subarachnoid spaces of the cerebral and cerebellar convexities; with the largest in the right posterior high frontal parafalcine region is seen measuring 12 X 8 mm. Those lesions seen within the left sylvian fissure shows typical nodular branching with grape-like or racemose pattern. These lesions are associated with mild focal meningeal enhancement. They show predominantly low T1 and T2 as well as GRE/ SWI signal intensities with no restricted diffusion. They are associated with mild vasogenic brain edema.  
  • Mild supra and infra-tentorial hydrocephalic changes with mild peri-ventricular T2/FLAIR hyperintensity.
ct

CT study shows these lesions as small calcified lesions predominantly within the extra-axial subarachnoid spaces.

Case Discussion

Multiple bilateral supra- and infra-tentorial predominantly extra-axial as well as intra-axial ring enhancing and calcified lesions , consistent with neurocysticercosis (granular / calcified phase) with mild supra- and infra-tentorial hydrocephalic changes.     

The main differential diagnosis is tuberculosis; however it is :

  • parenchymal marginally enhancing cystic lesions with tuberculous basal meningitis. The tuberculoma may show restricted diffusion with T2 hypointense wall.
  • extra-cerebral pulmonary lesions is common association.              

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.