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

Acta Neurol Scand. 1997 Aug;96(2):76-81. doi: 10.1111/j.1600-0404.1997.tb00243.x.


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.

Publication types

  • Clinical Trial

MeSH terms

  • Albendazole / therapeutic use
  • Anthelmintics / therapeutic use
  • Brain Diseases / complications
  • Brain Diseases / diagnosis*
  • Brain Diseases / parasitology
  • Clinical Protocols / standards
  • Cysticercosis / complications
  • Cysticercosis / diagnosis*
  • Cysticercosis / drug therapy
  • Diagnosis, Differential
  • Follow-Up Studies
  • Granuloma, Foreign-Body / complications
  • Granuloma, Foreign-Body / diagnosis*
  • Granuloma, Foreign-Body / drug therapy
  • Granuloma, Foreign-Body / parasitology
  • Humans
  • India
  • Likelihood Functions
  • Prospective Studies
  • Retrospective Studies
  • Seizures / drug therapy
  • Seizures / parasitology*
  • Seizures / pathology
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed / standards*
  • Tuberculoma / diagnosis


  • Anthelmintics
  • Albendazole