Solitary neurocysticercosis mimicking tuberculoma and glioblastoma: A diagnostic challenge in a low-resource setting.

BACKGROUND

Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system and a major cause of acquired epilepsy in endemic regions. Solitary parenchymal lesions frequently mimic tuberculoma or high-grade glioma, posing a significant diagnostic challenge, particularly in tuberculosis-endemic and resource-limited settings.

CASE DESCRIPTION: We report the case of a 60-year-old male farmer with diabetes mellitus who presented with a 1-week history of focal seizures with secondary generalization and progressive left-sided weakness. Neurological examination revealed a Glasgow Coma Scale score of 15/15 and grade 4+ power in the left upper and lower limbs, with no sensory deficit. The patient had a prior history of treated pulmonary tuberculosis. Brain magnetic resonance imaging demonstrated a solitary ring-enhancing lesion in the right medial frontal lobe, with differential diagnoses of tuberculoma versus high-grade glioma. He underwent right parietal craniotomy with a transcortical approach and gross total excision of a well-circumscribed lesion. Histopathological examination revealed a cysticercus larva with surrounding inflammatory infiltrate, confirming NCC. Postoperatively, the patient received albendazole (15 mg/kg/day) for 2 weeks and continued antiepileptic therapy. Follow-up imaging showed complete resolution of the lesion, and the patient remained seizure-free with full neurological recovery.

CONCLUSION

NCC should be considered in the differential diagnosis of solitary ring-enhancing brain lesions even in patients with prior tuberculosis. When imaging is inconclusive, surgical excision provides definitive diagnosis and effective treatment with excellent neurological and seizure outcomes.