Diffuse multiple cystic lesions in the brain

By Staff 2 Min Read
Anjali Bharani.

Department of Paediatrics, Mahatma Gandhi Memorial Medical College and M. Y. hospital, Indore, Madhya Pradesh, India.

ADDRESS FOR CORRESPONDENCE
Dr Anjali Bharani (Associate Professor), Department of Paediatrics, Mahatma Gandhi Memorial Medical College, and M. Y. Hospital, Indore, Madhya Pradesh, India.
Email: [email protected]

Keywords
Disseminated cysticercosis, cysticercal encephalitis, T. solium

A 10-year-old female child presented with fever, irritability, altered sensorium for 20 days and inability to speak for 15 days. There was no contact with a patient suffering from tuberculosis (TB). On examination, she was febrile, disoriented, had hypertonia with brisk deep tendon reflexes along with left sided upper motor neuron type facial palsy and meningeal irritation. Other systems were normal. Investigations revealed normal cerebrospinal fluid (CSF) analysis, normal X-ray chest, normal stool examination and negative Mantoux test. HIV serology also was negative. MRI brain showed multiple intra-axial, extra-axial, extra-cranial hyperintense cystic lesions with intralesional hypointense foci (cyst with dot), involving bilateral cerebral hemispheres (capsule-ganglionic region), thalamus (Figure 1) and brainstem, bilateral cerebellar hemispheres, bilateral muscles of mastication, bilateral extraocular muscles, tongue, neck muscles, upper limb muscles (Figure 2). Multiple foci of calcification were also noted. Peripheral enhancement was seen on post contrast scan. Ophthalmic evaluation did not show any intra-ocular involvement.

Figure 1. MRI Brain (T2 weighted) transverse section showing diffuse multiple cystic lesions intra-axial and extra axial involving bilateral cerebral hemispheres and basal ganglia and meninges (red arrow)



Figure 2. MRI Brain sagittal (T1) and coronal sections (T2) showing diffuse multiple cystic lesions involving cerebellum, tongue (red solid arrow), extra-ocular muscles and neck muscles ( red arrow).
Figure 2. MRI Brain sagittal (T1) and coronal sections (T2) showing diffuse multiple cystic lesions involving cerebellum, tongue (red solid arrow), extra-ocular muscles and neck muscles ( red arrow).

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