Single Ring-Enhancing Lesion with the Lipid Peak on MR Spectroscopy

265 CliniCal DesCription A 12‐year‐old boy presented in our emergency department with chief complaints of two episodes of seizures, headache, vomiting, and bilateral ptosis for the past 7 days. On neurological examination, bilateral third cranial nerve palsies were seen. Contrast‐enhanced MRI of the brain revealed a conglomerate peripherally enhancing cystic lesion of size 9 mm in the tegmentum of the midbrain with perilesional edema [Figure 1]. The core of the cystic lesion was hyperintense on T2‐WI and hypointense on FLAIR images suggesting signal suppression and CSF‐like fluid contents. Eccentric scolex was seen on T2 W and FLAIR images. MR spectroscopy [Figure 1d] performed at short TE of 35 ms shows a lipid peak within the core of the lesion. A contrast‐enhanced CT scan [Figure 2a] showed a peripherally enhancing lesion with eccentric scolex in the right tegmentum of the midbrain, suggesting the possibility of neurocysticercosis (NCC). A provisional diagnosis of NCC was made, and the patient was put on a tapering dose of steroids. Follow‐up NCCT done after one month showed a decrease in the size of the lesion and perilesional edema [Figure 2b]. His ptosis improved after three months of clinical follow‐up.