Overview
Cysticercosis must be differentiated from other diseases that cause brain and ocular cyst lesions.
Differentiating neurocysticercosis from other brain cyst lesions
| Disease
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Prominent clinical features
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Lab findings
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Radiological findings
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| Neurocysticercosis
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- Parenchymal lesions: Presentation depends on the site and number of lesions.
Seizures are the most common presentation. It is mostly focal but can have a secondary generalization.
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Lab findings are nonspecific.
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| Brain abscess
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- Headaches are the most common symptom. Usually, headaches occur on the same side of the abscess and tend to be severe (not responding to analgesics).
- Fever is not a reliable sign .(2)
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- Lumbar puncture is contraindicated but when done, it was variable between patients.
- Culture from the CT-guided aspirated lesion helps in identifying the causative agent.
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- Contrast enhances CT provides rapid assessment of the size and number of the abscesses.
- MRI: Diffusion-weighted imaging (DWI) MRI can differentiate brain abscesses from cystic brain lesions with sensitivity and specificity of 96% (3)
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| Brain tumors
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- Most common presenting symptom is dull aching
headache.
- Usually, it's associated with other symptoms of increased intracranial pressure (ICP) as seizures, visual disturbances, nausea, and vomiting. (4)
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- CT may be used in localizing the tumor and getting a rough estimate on the dimensions.
- MRI: Gadolinium-enhanced MRI is the preferred imaging modality for assessing the extension of the tumor and its exact location. (4)
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| Brain tuberculoma
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- Brain tuberculomas has insidious onset of symptoms as compared to tuberculous meningitis.
- Presentations are usually due to the pressure effect, not the T.B. bacilli.
- Presenting symptoms and signs in order of occurrence: (5)
- Episodes of focal seizures
- Signs of increased intracranial pressure
- Focal neurologic deficits.
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T.B. should be investigated everywhere else in the body (e.g. peripheral lymphadenopathy, sputum and blood culture)
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- CT: Contrast-enhanced CT scan shows a ring enhancing lesion surrounded by an area of hypodensity (cerebritis) and the resulting mass effect.
- MRI: Better than CT scan in assessing the site and size of the tuberculoma. Gadolinium-enhanced MRI shows a ring enhancing lesion between 1-5 cm in size (In NCC, the wall is thicker, calcifications are eccentric and the diameter is less than 2 cm)
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| Neurosarcoidosis
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70% of the patients present with the neurological symptoms rather than the presentation of systemic disease. Common presentations are:(6)
- Cranial neuropathies : Facial balsy is the most common presentation.
- Meningeal involvement: diffuse meningeal inflammation can cause diffuse basilar polyneuropathy in 40% of the patients. with neurosarcoidosis.
- Inflammatory spinal cord disease: Inflammatory span usually more than 3 spinal cord segments which helps to differentiate it from Multiple sclerosis.
- Peripheral neuropathy: Asymmetric polyneuropathy or mononeuritis multiplex. It may also manifest as GBS like presentation.
- HPO axis involvent: may present as diabetes inspidus. More thab 50% of the cases have no radiological signs.
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- Non invasive tests have low sensitivity and specificity.
- Serum ACE levels are elevated in 25% of the cases
- Lumbar puncture shows elevated spinal cord proteins together with mild-moderate pleocytosis. It is usually accompanied by oligoclonal bands.(6)
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MRI with contrast shows enhancement of the inflamed ares (i.e. cranial nerves, meninges or HPO axis)
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| Disease
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Prominent clinical feature
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Radiological findings
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| Ocular cysticercosis
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| Coats disease
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- Diagnosis made usually between 8-16 ys (rarely in adulthood)
- Wide range of symptoms from being asymptomatic to decreased vision and strabismus.
- Decreased visual acuity at initial presntation has poor prognosis. (7)
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- Fundus examination reveals vascular lesions and exudates.
- Fluorescein angiography is the best method to visualize the lesions.
- CT and MRI are reserved for atypical cases. (7)
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| Retinal Detachment
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- Most common presenting symptoms are photophopia nad floaters
- Visual field defects (described as curtain falling from periphery to the center) (8)
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- Ophthalmoscope is not reliable in detecting retinal detachment asthere might be associated haemorrhage
- Ultrasound can be used to identify and localize the detachment. (8)
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| Thyroid Ophthalmopathy
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| Retinoblastoma
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References
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