Radiologic Mimicry Between Glioblastoma and Neurocysticercosis: A Diagnostic Challenge

Le résumé fourni par la source

A 73-year-old woman presented with progressive left-sided hemiparesis. Initial brain MRI revealed three right-sided ring-enhancing lesions with cerebrospinal fluid-like cores, perilesional edema, and an eccentric, scolex-like enhancing nodule, suggestive of neurocysticercosis. Despite empirical antiparasitic and corticosteroid therapy, the lesions progressed. A stereotactic biopsy was performed but yielded only hemorrhagic. After brief clinical stabilization, the patient returned with worsening neurological deficits and radiological disease progression. Subsequent surgical resection of the largest lesion confirmed the diagnosis of IDH wild-type glioblastoma (WHO grade 4). This case highlights the diagnostic challenges in distinguishing multifocal glioblastoma from neurocysticercosis when the imaging features strongly overlap. A persistent, distinct enhancing nodule, initially interpreted as a scolex-like structure, was considered supportive of neurocysticercosis. However, because the scolex is not expected to remain as a discrete enhancing nodule in the colloidal vesicular stage, this finding should instead have served as an early clue to tumor mimicry. Ultimately, meticulous longitudinal imaging follow-up and definitive surgical histopathology are essential to prevent misdiagnosis and ensure appropriate management of atypical cystic brain lesions.

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