Ring-Enhancing Lesions in the Brain: A Diagnostic Dilemma

How to Cite This Article: Shetty G, Avabratha K.S, Rai B.S. Ring-Enhancing Lesions in the Brain: A Diagnostic Dilemma. Iran J Child Neurol. 2014 Summer;8(3): 61-64.AbstractThe most common radiological abnormality seen in young Indian patients with epilepsy is single small enhancing (ring/disc) computed tomographic (CT) lesions. The two most common differential diagnosis of this lesion in clinical practice include neurocysticercosis (NCC) and tuberculomas. They have similar clinical and neuroimaging features. Few researchers believe that in poor and developing countries (where both tuberculosis and NCC are common) that it is difficult to differentiate between tuberculomas and a single cysticercal granulomas.We report a case of a 6-year-old female patient who presented with complex partial seizures. The patient’s neuroimaging showed a single ring-enhancing lesion in the brain that was not differentiated between NCC and Tuberculoma.Finally, Magnetic resonance spectroscopy (MRS) was suggestive of tuberculoma that was successfully treated with antituberculosis therapy.This report highlights diagnostic difficulties with conventional investigations in single ring enhancing lesions in the brain and role of MRS in a diagnosis. MRS is helpful in differentiating these two conditions. ReferencesSeth R, Kalra V, Sharma U, Jagannathan N. Magnetic resonance spectroscopy in ring enhancing lesions. Indian pediatrics. 2010;47(9):803-4. Epub 2010/11/05.Rudresh K MKM, Karthik, Sebastin J. Clinical and Aetiological Profile of Ring-enhancing Lesions on CT Brain. Journal of Indian Academy of Clinical Medicine. 2008;9(2):100-2.RK G. Single enhancing computerized tomography– detected lesion in immunocompetent patients. Neurosurg Focus 2002;12(6):1-9.Singhi P RM. Focal seizure with single small ring enhancing lesion Seminars in Pediatric Neurology. 1999;6(3):196-201.Sethi PP, Wadia RS, Kiyawat DP, Ichaporia NR, Kothari SS, Sangle SA, et al. Ring or disc enhancing lesions in epilepsy in India. The Journal of tropical medicine and hygiene. 1994;97(6):347-53. Epub 1994/12/01.Jain AP JR, Lathia T. Single Small Enhancing Computed Tomography Lesion: A Review. Journal of Indian Academy of Clinical Medicine. 2005;6(2):114-21.Gujar SK, Maheshwari S, Bjorkman-Burtscher I, Sundgren PC. Magnetic resonance spectroscopy. J Neuroophthalmol. 2005;25(3):217-26. Epub 2005/09/09.Pretell EJ MCJ, Garcia HH, Alvarado M, Bustos JA, Martinot C. Differential diagnosis between cerebral tuberculosis and neurocysticercosis by magnetic resonance spectroscopy. J Comput Assist Tomogr. 2005;29:112-4.Santy K, Nan P, Chantana Y, Laurent D, Nadal D, Richner B. The diagnosis of brain tuberculoma by (1)H-magnetic resonance spectroscopy. Eur J Pediatr. 2011;170(3):379-87. Epub 2011/02/09.Gutch M, Jain N, Agrawal A, Modi A. MR spectroscopy in tuberculoma of brain. BMJ Case Rep. 2012;2012. Epub 2012/05/19

Staphylococcal scalded skin syndrome: A dermatological emergency in pediatrician′s hand

Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated exfoliating skin condition predominated by desquamation and blistering. Retrospective analysis of cases between 2010 and 2012, over a period of 2 years identified eight cases with SSSS. All cases identified were under 1 year of age. Erythema and exfoliative lesions were the initial symptoms followed by fever. Blood culture was positive for Staphylococcal aureus in 25% cases and pus culture positive in 37%. No methicillin-resistant S. aureus were found and all responded to common antibiotics. Due to early identification and antibiotic treatment, all the cases recovered completely