The Clinicoradiological Profile of Ring-enhancing Lesions in the Brain among Children 1 Month–18 Years of Age in a Tertiary Care Hospital

INTRODUCTION: Ring-enhancing lesions (RELs) in the pediatric brain represent a complex and heterogeneous group of pathological conditions that pose significant diagnostic and therapeutic challenges for clinicians and radiologists. Neuroimaging techniques, particularly magnetic resonance imaging (MRI) with contrast enhancement, play a pivotal role in characterizing these lesions. However, radiological findings alone are often insufficient, necessitating comprehensive clinical correlation and, in some cases, histopathological confirmation. This research aimed to provide a comprehensive analysis of the clinicoradiological profile of ring-enhancing brain lesions among children, focusing on demographic characteristics, radiological patterns, etiological distribution, and clinical outcomes in a tertiary care hospital setting. METHODS: We performed a prospective, observational study in children aged between 1 month and 18 years with ring-enhancing lesions on MRI brain at the department of pediatrics at our institute from April 2023 to February 2025. The aim of this study was to study the clinicoradiological profile of ring-enhancing lesions in the brain among children between 1 month and 18 years of age at a tertiary care referral center. Approval was obtained from the institutional scientific and ethical committee before initiating the study. RESULTS: This study of 31 children between 1 month and 18 years of age demonstrated that tuberculoma was the most common cause of RELs, followed by neurocysticercosis, cerebral abscess, and neurobrucellosis. The clinical presentation was dominated by seizures with the 6-10 years' age group being most commonly affected. MRI proved to be an invaluable diagnostic tool, with characteristic patterns helping differentiate various etiologies. The management approach was tailored to the underlying etiology, with all patients receiving anti-edema measures and antiseizure medication. Specific antimicrobial therapy included albendazole for neurocysticercosis, anti-tubercular therapy for tuberculomas, and broad-spectrum antibiotics for cerebral abscesses. Surgical intervention was primarily required for cerebral abscesses (66.7% of abscess cases), while the majority of tuberculomas and all neurocysticercosis cases were managed medically. DISCUSSION: RELs of the brain represent a significant clinical challenge in pediatric neurology practice, particularly in developing countries where infectious etiologies predominate and the presentation is not only in form of seizures. This study underscores the importance of a comprehensive diagnostic approach incorporating detailed clinical evaluation, neuroimaging, and when necessary, microbiological studies for the accurate diagnosis and appropriate management of pediatric ring-enhancing brain lesions involving pediatric neurology and neurosurgery team. CONCLUSION: Early recognition and prompt treatment are crucial for preventing neurological sequelae and optimizing the outcomes in this vulnerable population. Furthermore, public health measures targeting the prevention of tuberculosis and cysticercosis should be strengthened to reduce the burden of these preventable causes of neurological morbidity in children.