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Indicate Size Of NCC Lesions Using MRI CD Scan

Posted on Mon, 21 Apr 2014

Question: Patient(F) have two calicified Granulomas and a gliotic area in Brain . Wanted to know the size of each. Please let me know if I provide the MRI CD scan images Will you be able to tell the size and location of them in the latest MRI?

Answered by Dr. Indu Kumar (1 hour later)

Brief Answer: There is no need to concern about the size. Detailed Answer: Hello XXXXXXX Thanks for writing back You shouldn't be concerned about the size of lesions. MRI scan findings are typical of Neurocysticercosis(N.C.C) involving right frontal and occipital region of brain. Lesions of N.C.C are generally small in size and it measures 3- 4 mm in active stage. There are four stages of N.C.C and when they become inactive and in calcified stage these become pin head size and measures 3-4 mm.So,size is not the concerning factor.It is universal in all cases. Latest report shows lesions are in healed stage i,e calcified stage and there is no edema around the lesions.This is a good sign. Focal Gliotic changes in brain are in response to injury to brain tissue.At that time patient's brain was insulted by inflammation and edema so gliosis is residual effect. Treatment of N.C.C consists of antihelminthic drugs and anti epileptic drugs. Get well soon. Hope I have answered your question. Further queries are most welcome. Take Care Dr.Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indu Kumar (8 minutes later)

Hi Dr. XXXXXXX Can I send the MRI CD? then if you can tell the size as well as the stage of it. It will help me to understand it better. Thanks,

Answered by Dr. Indu Kumar (1 hour later)

Brief Answer: Please find detail answer below. Detailed Answer: Hello XXXXXXX Thanks for writing back I have gone through your reports in detail. Latest report shows only calcified lesions means it is in healed calcified stage(last stage).There are no active lesions.Calcifications are 3-4 mm size in all healed cases of calcified granulomatous lesions. If you wish to send CD for review,you can contact customer care of healthcaremagic.You can send through attachments of healthcare magic with reference to Dr.Indu XXXXXXX Kumar. Get well soon. Hope I have answered your question. Further queries are most welcome. Take Care Dr.Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indu Kumar (4 hours later)

Hi Dr. XXXXXXX Can I send the MRI CD? then if you can tell the 1) size as well as the 2) stage of it. It will help me to understand it better. 3) what are the chances of seizure in this case depending on two calicified Granulomas and a gliotic area in Brain? 4) Can this two calicified Granulomas and a gliotic area can go off in future. 5) Can they cause some other problems? 6) According to your experience, what happens after this particular situation in the later stages with calicified Granulomas and a gliotic area? Thanks,

Answered by Dr. Indu Kumar (1 hour later)

Brief Answer: Please find detail answer below. Detailed Answer: Hello XXXXXXX Thanks for writing back I have gone through your MRI images in detail. Lesions are in stage four(calcified stage) and 3-4 mm in size. As discussed earlier,imaging findings are typical of N.C.C. Chances of seizure depend upon electric activity in the brain and it varies with patient to patient. Generally patients need to take antiepileptic drugs for some time even after control of worms. Calcifications and gliotic changes in brain will last for whole life.These are benign findings and it doesn't require any treatment. These lesions will not cause any problems in future. Get well soon. Hope I have answered your question. Further queries are most welcome. Take Care Dr.Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indu Kumar (31 hours later)

Hi Dr. XXXXXXX Thanks for the reply. I have few more questions: 1) What is the software and it’s version I can use to see this MRI CD? 2) In typical NCC cases the calcified granulomas exist forever or go off after certain time like 3 yr or 5 yr or 10 yr or 15 yr or more? 3) Particularly in this case patient is taking Lavera (1000 mg x 2) from 2010 till date and never had a Seizure in between. A) Does it mean the patient can stop medication? B) Patient will not have seizure after stopping medication? 4) In particularly this case, is it the calcified granulomas have some good chances to go off in some time nearby? 5) What usually happens after the 4th stage of calcified granulomas when NCC is healed cases in patient life time? Is there any good link I can read? Thanks,

Answered by Dr. Indu Kumar (17 hours later)

Brief Answer: Please find detail answer below. Detailed Answer: Hello XXXXXXX Thanks for writing back Generally MRI CD has its own viewer software (DICOM viewer) on the CD.There shouldn't be any problem in opening. If you don't have the software you may check online sites which distribute free DICOM viewers. Pin head size calcification in brain can last for life time and may disappear after few years in some cases. It is totally benign condition and doesn't require any treatment. You should follow your neurologists advise regarding stoppage of anti epileptic drugs. Chances of seizure after healed calcified stage of N.C.C varies with patient and it differs from patient to patient. You can visit any any neurology site for details of N.C.C. Get well soon. Hope I have answered your question. Further queries are most welcome. Take Care Dr.Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indu Kumar (41 hours later)

Thanks Dr. XXXXXXX I tried to use MicroDicom from some website but it is crashing, can you please suggest some website from where I can download the free Dicom viewer. And any website that give more detail of NCC. Thanks,

Answered by Dr. Indu Kumar (6 hours later)

Brief Answer: Please find detail answer below. Detailed Answer: Hello XXXXXXX Thanks for writing back You use ezDICOM software. You can visit the following link for detailed information http://emedicine.medscape.com/article/0000-overview Get well soon. Hope I have answered your question. Further queries are most welcome. Take Care Dr.Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indu Kumar (40 hours later)

Thanks Dr. XXXXXXX Is there any link for ezDicom? I tried but most of the link software are not working. Thanks,

Answered by Dr. Indu Kumar (7 hours later)

Brief Answer: Please find detail answer below. Detailed Answer: Hello XXXXXXX Thanks for writing back You can go to below mentioned link.Free download is available here. http://www.e-dicom.com/ Get well soon. Further queries are most welcome. Take Care Dr.Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar