A study on Granuloma of Brain.

Balaji, G (2010) A study on Granuloma of Brain. Masters thesis, Madras Medical College, Chennai.


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Single ring enhancing cystic lesions may occur in several infectious and neoplastic diseases of the central nervous system and are the most common radiological abnormality seen in patients with acute-onset seizures in India and many other developing countries. Histopathological studies in India and in other countries revealed that neurocysticercosis (NCC) is the most likely cause of these lesions provided they fulfill a rigid set of clinical and radiological criteria. A single degenerating cyst is the most frequent finding associated with NCC in the Indian subcontinent30.Single cysticercus granuloma measures less than 20 mm in diameter, may be associated with cerebral edema not severe enough to produce midline shift, and occur in patients with seizures, normal neurological status, and no evidence of active systemic disease. When these lesions resolve spontaneously, either disappearing or changing into a calcified nodule, the diagnosis of NCC is very likely. The second most common cause of these CT-detected lesions is tuberculoma; in patients with these lesions similar clinical and neuroimaging features are also present. In a developing country like ours where both tuberculosis and Cysticercosis are common, it is difficult to differentiate between tuberculoma and a single cysticercal granuloma. The most interesting feature of these solitary enhancing lesions is their spontaneous disappearance within weeks or months. Some lesions "heal" by becoming calcified. These patients require only antiepileptic therapy, and this medication may be withdrawn safely after the lesion has resolved on CT scanning. In several studies provision of anticysticercal drugs has been attempted, but because of conflicting results, their role in the management of these single lesions is uncertain. Magnetization transfer, a new technique for improving image contrast in magnetic resonance (MR) imaging, is based on application of off-resonance radio-frequency pulses and observing their effects on MR images, as well as measuring the signal intensity with and without application of the pulses (i.e., magnetization transfer ratio. MTRs can be used to detect changes in the structural status of brain parenchyma that may or may not be visible with standard MR techniques. 1. The observed mean age of incidence of single ring enhancing Neurocysticercosis was 24 with a male female ratio of 2:1. 2. Partial seizures were the most common seizure type at presentation of which right focal motor semiology was the commonest. 3. Majority of granulomas occurred in the parietal lobes (Left > Right). 4. Seizures recurred in 11 of the 35 patients (31%) in the follow up period of 12 months. 5. Follow up contrast CT revealed a complete resolution of 17 cysts (48%) at 6 months and 23cysts (65%) at 12 months. 6. Treatment with Albendazole did NOT statistically “reduce the incidence of recurrent seizures” or “shorten the time to cyst disappearance.” 7. The only parameter associated with seizure recurrence statistically (p=0.034) with was the persistence of abnormalities at 12 months CT scan (partial resolution / calcification). 8. The high incidence of a resultant calcific lesions among patients with recurrences is an observation different from other studies. 9. The Magnetisation transfer ratio from the cyst wall of the neurocysticercosis granuloma at the time of inclusion in ranged from 18.4 to 22.90. 10. MT ratio differentiated Tuberculoma and degenerating NCC with a sensitivity of 78%, and specificity of 73%.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Granuloma ; Brain.
Subjects: MEDICAL > Neurology
Depositing User: Kambaraman B
Date Deposited: 28 Jun 2017 11:30
Last Modified: 28 Jun 2017 11:30
URI: http://repository-tnmgrmu.ac.in/id/eprint/573

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