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

Rajshekhar, V. ; Chandy, M. J. (1997) Validation of diagnostic criteria for solitary cerebral cysticercus granuloma in patients presenting with seizures Acta Neurologica Scandinavica, 96 (2). pp. 76-81. ISSN 0001-6314

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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.

Item Type:Article
Source:Copyright of this article belongs to John Wiley and Sons.
Keywords:Computerized Tomography; Cysticercosis; Diagnosis; Epilepsy; Tuberculoma
ID Code:95446
Deposited On:14 Feb 2013 11:33
Last Modified:14 Feb 2013 11:33

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