Differential Diagnosis Between Cerebral Tuberculosis and Neurocysticercosis by Magnetic Resonance Spectroscopy

Abstract

Single enhancing brain lesions (SELs), mostly as a result of neurocysticercosis or tuberculosis, are a common cause of seizures. Ten patients with SELs caused by neurocysticercosis (n=6) or tuberculosis (n=4) were examined by proton magnetic resonance spectroscopy. Tuberculomas had a high peak of lipids, more choline, and less N-acetylaspartate and creatine. The choline/creatine ratio was greater than 1 in all tuberculomas but in none of the cysticerci. Magnetic resonance spectroscopy differentiates SELs caused by cysticercosis or tuberculosis and may avoid brain biopsies or unnecessary antituberculosis treatments.

Neurocysticercosis as Solitary Parenchymal Lesion Confirmed by Mitochondrial Deoxyribonucleic Acid Sequence Analysis-Case Report-

“…1,3) Recently, MR spectroscopy has been proposed as a useful method for the diagnosis of neurocysticercosis. 5,6,9,10) The combination of elevated lactate, alanine, succinate, and choline levels, and reduced NAA and creatine levels helped to characterize a cystic intraaxial lesion in the brain as neurocysticercosis. 9) Pyruvate is the predominant metabolite in cysticercosis cysts.…”

“…13,14) However, very few cases have been examined using these methods. 5,6,9,10,13,14) Here we present a case of neurocysticercosis identified by MR spectroscopy and confirmed as solitary parenchymal lesion caused by the Asian genotype of T. solium by mitochondrial DNA sequence analysis.…”

“…1,3) The larvae can cause cyst formation in any tissue, including the central nervous system (CNS). Cysticercosis in the CNS, or neurocysticercosis, is a very common disease in Central and South America, Asia, and Africa, [1][2][3][4][5][6][9][10][11][12][13][14] although a few cases have been reported in Japan. 7,8) Patients with neurocysticercosis often present with varied and non-specific symptoms including seizures and focal neurological deficits.…”

“…Recently, MR spectroscopy has been reported to be useful for non-invasive diagnosis. 5,6,9,10) Mitochondrial deoxyribonucleic acid (DNA) sequence analysis of the specimens can also provide a definitive diagnosis. 13,14) However, very few cases have been examined using these methods.…”

“…3) The clinical diagnosis of neurocysticercosis has been based on the patient history, radiographical findings, and pathological confirmation. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Magnetic resonance (MR) imaging is also valuable for the diagnosis. However, T 1 -weighted MR imaging with gadolinium may show neurocysticercosis as a solitary parenchymal lesion, which cannot be differentiated from other solitary lesions including other types of parasites and tuberculosis.…”