Radiology Case Presentation: Differential Diagnosis of Large Posterior Fossa Mass in 25-Year-Old Male
25-year-old male with persistent headaches and neck pain presents with worsening symptoms. Differential diagnosis includes primary brain tumor, pyogenic abscess, pilocytic astrocytoma, medulloblastoma, and other possibilities. Neurocysticercosis, a parasitic disease caused by T. solium, endemic in certain regions, is also considered due to the patient's background. Imaging is crucial for diagnosis, with treatment options including antiparasitics, anti-inflammatories, and surgery.
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CASE PRESENTATION SHIKHA BHATIA RADIOLOGY ELECTIVE 06/02/17
J. P. 25 Y/O M PRESENTED TO ED C/O PERSISTENT HEADACHES OVER SEVERAL MONTHS PREVIOUSLY SEEN IN CULPEPPER, DX ED CERVICAL STRAIN FEELS DULL & IN THE BACK OF HIS HEAD WITH INTERMITTENT, SHARP NECK PAIN MOVED FROM HONDURAS 3 YEARS AGO CUTS TREES FOR WORK HEADACHES WORSE OVER LAST WEEK, ESP IN AM, AND ASSOCIATED WITH DIZZINESS PEX: NO PAPILLEDEMA, NARROW STATION, UNSTEADY TANDEM GAIT, O/W NORMAL NO WEIGHT LOSS, NIGHT SWEATS, GI UPSET LABS: LFTS, O/W NORMAL
DIFFERENTIAL LARGE POSTERIOR FOSSA MASS IN 25 Y/O PRIMARY BRAIN TUMOR PYOGENIC ABSCESS PILOCYTIC ASTROCYTOMA MEDULLOBLASTOMA TUBERCULOMA MYCOTIC GRANULOMA GLIOBLASTOMA METASTATIC BRAIN TUMOR TOXOPLASMOSIS CYSTIC LESIONS NOCARDIA NEUROCYSTERCIRCOSIS ECHINOCOCCOCIS CYSTIC GLIOMA
NEUROCYSTERCIRCOSIS PARASITIC DISEASE CAUSE BY T. SOLIUM, WHICH IS ENDEMIC IN SOUTH AMERICA, ASIA, AND AFRICA WEEKS TO YEARS FOLLOWING INGESTION, TISSUE CYSTICERCI DEVELOP IN VARIOUS SITES, INCLUDING THE BRAIN SYMPTOMS DEPEND ON LOCATION SEIZURES (INTRAPARENCYMAL) AND HA, N/V (SUBARACHNOID) DIAGNOSIS IMAGING MOST COMMON, BUT SEROLOGY, FUNDOSCOPIC EXAM, SPINAL STUDIES AND BIOPSY MAY ALSO AID TREATMENT ANTIPARASTICS, ANTI-INFLAMMATORIES, SURGERY
IMAGING FINDINGS IMAGING FINDINGS VARY BASED ON STAGE OF INFECTION VESICULAR CYSTIC, HYPODENSE, ROUND COLLOID VESICULAR CYST BEGINS TO DEGENERATE: CYST WALL AND CAVITY INCREASES IN INTENSITY, SURROUNDING ENHANCEMENT 2/2 EDEMA GRANULAR NODULAR CYST RETRACTS, EDEMA DECREASES, DECREASED ENHANCEMENT NODULAR CALCIFIED CALCIFIED GRANULOMA, NO ENHANCEMENT ONLY PATHOGNOMONIC FINDINGS = SCOLEX ELONGATED, BRIGHT NODULE WITHIN CYST CAVITY (FIG. B) ENHANCING LESIONS AND PARENCHYMAL CALCIFICATIONS ARE ALSO HIGHLY SUGGESTIVE; MAY ALSO P/W HYDROCEPHALUS AND LEPTOMENINGEAL ENHANCEMENT
WHAT HAPPENED? NEUROSURGERY CONSULTED SUBOCCIPITAL CRANIOTOMY WITH RESECTION THE WALL OF THE LESION WAS OPENED, AND A WHITE-COLORED TENDRIL WAS UNRAVELED AND PULLED FROM INSIDE THE CYST C/B HEMORRHAGE REQUIRING EVACUATION AND ANEURYSM CLIPPING UNCOMPLICATED RECOVERY FOLLOWING DISCHARGED POST-OPERATIVE DAY 22 ONCE STABLE GIVEN BACLOFEN, MECLIZINE, ZOFRAN, AND SCOPOLAMINE PATCHES, WITH CONTINUED REHAB
REFERENCES GAILLARD, FRANK. "NEUROCYSTICERCOSIS." RADIOPAEDIA. 01 JAN. 2017. WEB. 01 JUNE 2017. WHITE AC, WELLER PF, AND BARON EL. "CLINICAL MANIFESTATIONS AND DIAGNOSIS OF CYSTERCERCOSIS." UPTODATE. 16 DEC 2016. WEB. 31 MAY 2017.
