Validation of diagnostic criteria for solitary cerebral cysticercus granuloma in patients presenting with seizures.

Abstract

OBJECTIVE:

To evaluate a set of clinical and computed tomographic (CT) criteria (previously described by us) to predict the diagnosis of a solitary cerebral cysticercus granuloma (SCCG) at initial presentation, in patients presenting with seizures.

MATERIAL AND METHODS:

The diagnostic criteria were applied prospectively to patients presenting with seizures and solitary lesion on the CT scan. The clinical diagnostic criteria were as follows: seizures should be the presenting complaint; there should be no evidence of persistent raised intracranial pressure, progressive neurological deficit or an active systemic disease. The CT diagnostic criteria were: evidence of a solitary contrast enhancing lesion measuring 20 mm or less in its maximal dimension without a shift of the midline structures due to the surrounding oedema. A diagnosis of SCCG was made only when all the clinical and CT criteria were fulfilled. Over a period of 36 months, we managed 401 patients presenting with seizures and a solitary mass on the CT scan; 215 met the criteria for the diagnosis of an SCCG.

RESULTS:

Of the 215 patients initially diagnosed to have an SCCG, 197 were ultimately determined to have that diagnosis (true positive diagnosis) while 16 were excluded because of lack of follow-up CT assessment. Two of the 215 patients with the initial diagnosis of an SCCG subsequently had histological diagnosis of a secondary metastasis and a pyogenic abscess (false positive diagnosis). Our set of diagnostic criteria for SCCG had a sensitivity of 99.5%; specificity of 98.9%; a positive predictive value of 99%; and a negative predictive value of 99.5%. The likelihood ratios for the positive and negative tests were 92.99 and 0.005 respectively.

CONCLUSIONS:

Our diagnostic criteria help in not only accurately identifying an SCCG but also in differentiating it from a solitary tuberculoma and other brain masses. However, confirmation of the diagnosis of an SCCG is only obtained at follow-up evaluation and therefore careful clinical and CT re-evaluation is essential in all patients initially diagnosed to have an SCCG.

• Authors: V Rajshekhar, M J Chandy
• Journal: Acta neurologica Scandinavica (Acta Neurol Scand) Vol. 96 Issue 2 Pg. 76-81 (Aug 1997) ISSN: 0001-6314 [Print] Denmark
• PMID: 9272181 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Anthelmintics
• Albendazole

Topics

• Albendazole (therapeutic use)
• Anthelmintics (therapeutic use)
• Brain Diseases (complications, diagnosis, parasitology)
• Clinical Protocols (standards)
• Cysticercosis (complications, diagnosis, drug therapy)
• Diagnosis, Differential
• Follow-Up Studies
• Granuloma, Foreign-Body (complications, diagnosis, drug therapy, parasitology)
• Humans
• India
• Likelihood Functions
• Prospective Studies
• Retrospective Studies
• Seizures (drug therapy, parasitology, pathology)
• Sensitivity and Specificity
• Tomography, X-Ray Computed (standards)
• Tuberculoma (diagnosis)