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The calcified intracorporeal vacuole: an aid to the pathological diagnosis of solitary cerebral cysticercus granulomas
  1. J D PANDIAN
  1. Division of Neurology, Christian Medical College, Ludhiana, Punjab 141008, India
  2. jegarajpandian{at}hotmail.com
    1. G CHACKO
    1. Department of Neurological Sciences, Christian Medical College and Hospital, Vellore 632 004, Tamil Nadu, India
    2. geeta{at}neuro.cmc.ernet.in

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      I read with interest the paper by Chackoet al reporting the significance of calcified intarcorporeal vacuole:an aid to the pathological diagnosis of solitary cysticercus granulomas.1 I appreciate the efforts of the authors for once again proving that the aetiology for single small enhancing CT lesions is neurocysticercosis. The investigators are right in stating that in 26 patients there was no evidence of tuberculosis or fungal pathology. The presence of histiocytes and eosinophils favour a parasitic aetiology. It would be of interest to know the radiological correlation of oval calcified bodies that were detected in six patients. Did they have type A or type B lesions? The authors, in their earlier study, had concluded that neither the duration of seizures nor the type of lesion on CT was predictive of the presence of the parasite in the granuloma.2 I am keen to know the seizure control of these patients with oval calcified bodies, as the authors have stated that a small proportion of study patients had intractable epilepsy. Single small enhancing CT lesions are reported to be the cause of the seizure in 26% of Indian patients who present with partial seizures.Cysticercus granulomas and tuberculomas are the two common differential diagnoses that are considered in a patient with seizures and solitary enhancing lesion on CT.3 The authors have demonstrated very well the aetiology, diagnosis, and management of single small enhancing CT lesions in their previous studies.3-4 This study adds one more feather to their cap in confirming the aetiology of such leisons. It is heartening to see that general practioners, physicians, and even neurologists in this part of the country treat these patients with antituberculous drugs. Educating general practioners and general physicians about the nature and aetiology of these lesions will definitely improve the management of patients.

      References

      Chacko replies:

      All six patients with oval calcified bodies had type A lesions, of which two were ring lesions and four were discs.

      Follow up of 6 months to 3 years is available for four of these patients and they are all seizure free, with three of them still on antiepileptic medication.

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