Small single enhancing lesion in CT Brain Clinical and Radiological outcome.

Suresh, C T (2008) Small single enhancing lesion in CT Brain Clinical and Radiological outcome. Masters thesis, Madras Medical College, Chennai.


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Small single enhancing lesion in CT (SSECT)scan as an entity came into existence in India in early 1980, with the advent of CT scan. Tandon [et al.] labeled them as intracranial tuberculomas. They identified two types of lesions based on the appearance of the lesion in the C T Scan brain. Small ring and disc lesions were called as immature tuberculomas and large lobulated lesions were called as mature tuberculomas. ATT was invariably started in these patients. Sethi [et al.] & Bansal [et al.] noted that these lesions disappeared spontaneously without treatment. Natarajan and Arjundas [et al.] at the Institute of Neurology, Chennai also noted spontaneous disappearance of these lesions without specific treatment. The exact cause of these lesions could not be deciphered because apart from tuberculoma, cysticercus granuloma, pyogenic abscess, metastases, fungal granuloma, and glioma had been reported to cause similar appearance in CT scan brain as more centers acquired C.T.Scan facility. Hence the exact aetiology of these lesions became a subject of speculation. A significant breakthrough came in 1987 at Vellore 8 when stereo tactic biopsy was done on 15 patients with SSECT. Most of the lesions were identified as cysticercus and none were of tuberculous etiology. Bhargava and Tandon in 1988 and Wadia, Makhalle in 19863,4, found evidence of tuberculous lesions in histopathology. However they failed in defining the size of the lesion. Rajshekhar etal8 then defined a small single lesion based on CT appearance as “A solitary, contrast-enhancing lesion of less than 20-mm diameter lesion without severe cerebral edema (no midline shift)”.this definition is often equated to cysticercous granuloma but there is every possibility that these lesions could be a tuberculoma. 1) By three months most of the SSECT resolve without calcification and by 1 year all lesions resolve either by resolution or calcification. 2) Enlargement of a lesion may not be always paradoxical and it can be a natural course in the evolution of the lesion. 3) SSECT present as generalized tonic clonic convulsions or focal seizure with secondary generalization. 4) Seizure caused by SSECT are well controlled and most of them don’t have seizures beyond 3 months. 5) Patients who have seizures are usually secondary to calcified lesions. 6) Specific treatment in terms of anticysticidal or ATT is unnecessary as all lesions have better seizure control and radiological resolution when followed for 1 year. 7) Steroids might be useful in patients who have lesion with significant oedema. 8) Headache is a feature of calcified lesion. 9) The commonest location of SSECT in brain is parietal cortex.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Small single ; enhancing lesion ; CT Brain ; Clinical and Radiological outcome.
Subjects: MEDICAL > Neurology
Depositing User: Kambaraman B
Date Deposited: 28 Jun 2017 11:05
Last Modified: 28 Jun 2017 11:05

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