Ring enhancing lesions on neuroimaging of childhood symptomatic epilepsy-A clinico-pathological study

Pravakar Mishra, Deepak Ranjan, N Pattnaik, Junior Resident
International Journal of Medical Pediatrics and Oncology   unpublished
Seizures are the most common pediatric neurologic disorders with 4% to 10% of children suffering at least one seizure in the first 16 years of life. More than half of CT scans are found to be abnormal in childhood symptomatic seizures. Finding out a cause and early treatment can be not only life-saving but can increase the IQ and long term survival of a child. Ring enhancing lesion is a neuroimaging finding detected in selected cases of seizures in children. It is an abnormal radiologic sign
more » ... t appears as hypodense or isodense disc or target lesion with perifocal vasogenic edema. Worldwide, Neurocysticercosis prevails as the top most cause while Tuberculoma is the commonest cause in developing countries. This was a hospital based prospective study aimed to find out the clinicopathological features of seizures in 5-14 years age group showing ring enhancing lesion on neuroimaging. Out of 42 cases, majority of lesions found were tuberculoma (38%) followed by neurocysticercosis (33%) and brain abscess (20%). Nearly half of all lesions were detected in parietal lobe. Among tuberculoma cases, 13 lesions (81.2%) were found to be solitary and one was multiple (6.3%). But, out of all neurocysticercosis cases 7 (50%) were multiple and 5 (35.7%) were solitary lesions. Out of 42 cases, 24 (57.1%) got cured, 12 (28.6%) died and 6 children (14.3%) survived with sequlae after successful therapy. Distinguishing non-neoplastic causes from neoplastic ones is important because a misdiagnosis can lead to unwarranted neurosurgery and exposure to toxic chemotherapy and harmful brain irradiation.