1/4. Giant intraparenchymal neurocysticercosis: unusual MRI findings.We report a case of surgically proven giant neurocysticercosis (NCC). MR imaging revealed an unusually large solitary parenchymal cystic lesion showing signal intensity similar to CSF on all pulse sequences, with internal septations and a small nodule in the anterior aspect of this lesion compatible with this diagnosis. Identification of a scolex in a cystic lesion with CSF intensity plays a key role in the diagnosis of NCC. The presence of internal septations is an atypical feature.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/4. January 2004: elderly Filipino man with frontal lobe tumor.A 74-year-old Filipino man presented with new-onset partial-complex seizures. Eight months earlier he had a subtotal gastrectomy for adenocarcinoma classified as T1 N0M0 stage IA. He was irradiated. Two months later, he became confused and developed rhythmic, seizure-like movements of the extremities. A head CT revealed a 2 cm. right frontal lobe mass. On MRI, the mass exhibited ring enhancement and was surrounded by edematous white matter. The patient denied headache, weakness or constitutional symptoms. CT of the chest and abdomen revealed no evidence of metastatic spread or other abnormalities. His seizures were controlled with fosphenytoin and dexamethasone. Preoperatively the frontal lobe lesion was considered most likely to be either a metastatic or primary tumor. Resection of the frontal lobe lesion revealed a firm gliotic cystic mass. Crush preparations and frozen sections showed acute and chronic inflammation, gliosis, fibrosis, and many foreign body giant cells reacting to parasitic larval tissue. Intact and necrotic larval parts were surrounded by gliotic brain tissue containing foreign body giant cells, macrophages, and lymphocytes. However, eosinophils were not seen. Finally a refractive fragment resembling a hooklet and a fragmented scolex were identified that made a diagnosis of cysticercosis certain.- - - - - - - - - - ranking = 2keywords = giant (Clic here for more details about this article) |
3/4. Cysticercal chronic basal arachnoiditis with infarcts, mimicking tuberculous pathology in endemic areas.neurocysticercosis (NCC) is the most common of the parasitic diseases affecting the CNS, with protean clinical manifestations. stroke as a complication of NCC occurs in a very small percentage of cases, mostly involving small perforating vessels while major intracranial vessel involvement is extremely rare. The present report involves two autopsied cases of chronic cysticercal basal arachnoiditis causing large arterial territory infarcts and, in the second case, a hypothalamic mass. They were diagnosed and managed, clinically and by neuroimaging, as stroke and neurotuberculosis, respectively. The diagnosis was established only at autopsy, which revealed NCC causing basal arachnoiditis, major vessel vasculitis and infarcts. Histologically, case 1 showed degenerating racemose cysticercal cyst within the thick basal exudate. In the second case, remnants of the degenerated cysticercal cyst in the form of hooklets and calcareous corpuscles were identified within the giant cell inciting a granulomatous response to form a hypothalamic mass lesion mimicking tuberculoma. The present case report highlights the importance of considering the non-tuberculous etiologies of chronic basal arachnoiditis like NCC before initiating therapy especially in countries endemic to both NCC and tuberculosis, like india.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
4/4. Giant neurocysticercosis cyst in the cerebellar hemisphere.A 67-year-old man presented with dizziness, nausea, and ataxia. magnetic resonance imaging showed a large (5.5 x 4 x 4 cm) cystic lesion in the left cerebellar hemisphere with internal septation, a mural nodule, and thin rim enhancement. Cystic cerebellar tumor such as hemangioblastoma was initially suspected. Following surgery, the cyst was identified as cerebellar neurocysticercosis. neurocysticercosis is the most common parasitic disease of the central nervous system but is occasionally misdiagnosed as tumor because of the varying neuroimaging presentation. This case shows that neurocysticercosis should be considered in the differential diagnosis of giant cystic lesions in the cerebellum as surgical intervention may be unnecessary.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |