Solitary intracranial lesions due to neurocysticercosis (NCC): clinical presentations and MR imaging features

<h3>Background</h3> Solitary intracranial lesions can be diagnostically challenging. Neurocysticercosis is an uncommon, treatable differential diagnosis, with variable but characteristic imaging features depending on the stage of disease and use of appropriate imaging MRI sequences. <h3>Methods</h3> We performed a retrospective study of patients with a single brain lesion on MRI, meeting criteria for definite neurocysticercosis, referred to the UCLH Neuroparasitology MDT between 2015 and 2022. <h3>Results</h3> 20 patients (aged 16 - 66 years) met inclusion criteria. 19/20 presented with seizures and 1/20 with headache. 19/20 cases had a negative cysticercosis immunoblot, 1/20 was equivocal. 41% had a positive CSF and/or serum antigen ELISA. MRI at presentation demonstrated a visible scolex in 65%. The commonest lesion stage was colloidal vesicular (n=12), followed by granular nodular (n=6), vesicular (n=1), and nodular calcified (n=1) stages. 14/20 patients received treatment. Follow-up imaging demonstrated reduction of size in both treated and untreated lesions. Correlation of lesion size reduction with time interval was better in treated patients (r = 0.91). <h3>Summary</h3> Our study demonstrates the variable imaging spectrum of single NCC lesions. Increased awareness of this diagnosis is important to prevent unnecessary surgical intervention and timely initiation of anticysticercal treatment to mitigate the long-term risk of epilepsy.