ENLARGING SOLITARY CYSTICERCUS GRANULOMAS

Solitary cysticercus granulomas that produce seizures usually measure less than 20 mm in diameter and diminish in size spontaneously. Unlike live cysticercus cysts, they have not been known to increase in size. In a prospective follow-up study of 93 consecutive patients with epil epsy and small solitary lesions (< 20 mm in diameter) enhancing on com puterized tomography (CT), 91 were found to have solitary cysticercus granuloma; of these, seven (7.7%) were diagnosed as having an enlargin g cysticercus granuloma. Enlarging lesions were defined as those that, on follow-up CT, had increased by more than 50% of their original siz e but were still less than 20 mm in diameter (Group 1, three patients) or those that had increased to more than 20 mm (Group 2, four patient s). Excision biopsy is recommended for Group 2 solitary lesions, regar dless of the clinical progression, to eliminate the possibility of oth er pathologies. However, a trial of albendazole therapy with early CT re-evaluation (within 4 to 6 weeks) may be warranted in those with Gro up 1 lesions and in selected patients with Group 2 lesions. It is impo rtant to recognize the entity of enlarging solitary cysticercus granul oma to avoid mistaking it for a tuberculoma and treating the patient w ith empiric antituberculous therapy.