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 epilepsy and small solitary lesions (< 20 mm in diameter) enhancing on computerized tomography (CT), 91 were found to have solitary cysticercus granuloma; of these, seven (7.7%) were diagnosed as having an enlarging cysticercus granuloma. Enlarging lesions were defined as those that, on follow-up CT, had increased by more than 50% of their original size 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 patients). Excision biopsy is recommended for Group 2 solitary lesions, regardless of the clinical progression, to eliminate the possibility of other pathologies. However, a trial of albendazole therapy with early CT re-evaluation (within 4 to 6 weeks) may be warranted in those with Group 1 lesions and in selected patients with Group 2 lesions. It is important to recognize the entity of enlarging solitary cysticercus granuloma to avoid mistaking it for a tuberculoma and treating the patient with empiric antituberculous therapy.