Clinical and Investigative Profile of Ring-enhancing Lesions on Neuroimaging.

ABSTRACT

Aims: To analyze and evaluate ‘ring-enhancing’ appearance as a sign in the differential diagnosis of neurological lesions in the brain and clinically correlate such an appearance with patients’ mode of presentation, etiological factors, outcome and mode of management. Study Design: A cross-sectional study was done in 40 patients in whom ring-enhancing lesions were found on neuroimaging. They were retrospectively analyzed in view of their clinical presentation and investigative profile. Material and Methods: The study was conducted at the Dept. of Medicine, Shri Sayajirao General (SSG) Hospital, Vadodara, Gujarat. The study was conducted over a period of 24 months in 40 patients. Results: We observed that infective pathology was the most common etiology in patients with multiple ring-enhancing lesions of the brain. Tuberculosis (TB) and neurocysticercosis (NCC) were the most common infections. Neoplastic etiology was the commonest noninfective etiology. Conclusion: Our study establishes the role of TB as the leading cause of ring-enhancing lesions in the Indian setup as compared to tumors in the Western world. It might serve a basis for early recognition and intervention in these patients. We suggest that in patients with multiple ring-enhancing lesions of the brain, a CSF examination and imaging of chest should always be performed.