Seizures are a prevalent neurological manifestation in clinical practice, often necessitating comprehensive diagnostic evaluation to ascertain their etiology. Among the various causes, solitary enhancing lesions observed on computed tomography (CT) scans have garnered significant attention. These lesions, typically measuring less than 20 mm, are frequently associated with neurocysticercosis, particularly the granular-nodular stage known as solitary cysticercus granuloma (SCG) [1,2]. In India, SCG represents the most common form of neurocysticercosis and is a leading cause of new- onset seizures in both pediatric and adult populations [1,3]. The clinical presentation of seizures linked to SCG is often characterized by focal-onset seizures, with or without secondary generalization. Notably, these seizures are typically acute symptomatic and exhibit a favorable prognosis. Studies have demonstrated that a significant proportion of patients with SCG experience complete resolution of seizures following appropriate antiepileptic drug therapy, with recurrence rates being relatively low [2,4]. Despite the generally benign course, the presence of superficial solitary enhancing lesions on CT scans necessitates a thorough understanding of their implications in seizure pathogenesis. This study aims to elucidate the clinical and radiological characteristics of patients presenting with seizures associated with superficial solitary enhancing CT lesions, thereby contributing to the refinement of diagnostic and therapeutic strategies in managing such cases.

Study Design and Setting This was a prospective observational study conducted at the Department of Neurology, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India over a period of one years from January 2024 to January 2025. The study was approved by the institutional ethics committee, and informed consent was obtained from all participants or their guardians, Study Population Patients aged [age range, e.g., 5–60 years] presenting with new-onset seizures and showing superficial solitary enhancing lesions on CT scan were included. Exclusion criteria were: Multiple intracranial lesions on imaging History of prior seizures or epilepsy Evidence of other CNS infections, neoplasms, or metabolic causes of seizures Severe comorbid conditions limiting follow-up Clinical Evaluation Detailed clinical history and neurological examination were performed for all patients, including: Type, duration, and frequency of seizures Associated symptoms such as headache, vomiting, or focal deficits Past medical history and exposure to risk factors for neurocysticercosis Radiological Assessment All patients underwent non-contrast and contrast-enhanced CT scans of the brain using a 64-slice scanner. Lesions were assessed for: Location (lobar, cortical/subcortical) Size (maximum diameter in mm) Enhancement pattern Presence of perilesional edema MRI brain was performed in selected cases where the diagnosis was uncertain. Laboratory Investigations Routine laboratory investigations included: Complete blood count, serum electrolytes Liver and renal function tests Serum anti-cysticercal antibodies (where available) Treatment Protocol: - Patients were managed according to standard guidelines: Antiepileptic therapy: Initiated with monotherapy (e.g., carbamazepine or phenytoin) Antihelminthic therapy: Albendazole (15 mg/kg/day for 28 days) in selected cases Supportive care and follow-up were provided as needed Follow-Up Patients were followed at 1, 3, and 6 months to assess: Seizure recurrence Clinical recovery Radiological resolution of lesions on follow-up imaging Statistical Analysis Data were analyzed using SPSS version XX. Continuous variables were expressed as mean ± standard deviation, and categorical variables as percentages. Comparison between groups was done using Chi-square test for categorical data and t-test for continuous variables. A p-value <0.05 was considered statistically significant. Demographic and Clinical Profile A total of 60 patients were enrolled in the study. The mean age was 28.5 ± 12.3 years (range 8–60 years), with a male-to-female ratio of 1.3:1. Most patients (65%) presented with focal-onset seizures, while 35% had generalized tonic-clonic seizures. The mean duration from seizure onset to presentation was 5.2 ± 3.1 days. Associated symptoms included headache (40%), vomiting (25%), and focal neurological deficits (10%) (Table 1). Table 1. Clinical Characteristics of Patients (n=60) Characteristic Number (%) Male 34 (56.7) Female 26 (43.3) Focal-onset seizures 39 (65) Generalized seizures 21 (35) Headache 24 (40) Vomiting 15 (25) Focal neurological deficit 6 (10) Radiological Findings All patients underwent CT imaging. The majority of lesions were cortical/subcortical in location (70%), with the parietal lobe being the most common site (45%). The mean lesion size was 12.3 ± 4.1 mm. Perilesional edema was observed in 30% of patients, and all lesions showed ring or nodular enhancement (Table 2). Table 2. Radiological Characteristics of Lesions (n=60) Characteristic Number (%) Location – Parietal lobe 27 (45) – Frontal lobe 15 (25) – Temporal lobe 12 (20) – Occipital lobe 6 (10) Lesion size <15 mm 42 (70) Lesion size ≥15 mm 18 (30) Perilesional edema 18 (30) Enhancement pattern – Ring 36 (60) Nodular 24(40) Treatment and Outcome All patients were started on antiepileptic therapy, and 30 patients (50%) received albendazole therapy. During 6 months of follow-up, 90% of patients remained seizure-free, while 10% had a recurrence that was managed with adjustment of antiepileptic drugs. Follow-up imaging showed complete resolution of lesions in 85% and reduction in size in 15%. No major complications were observed. Table 3. Treatment and Follow-Up Outcomes (n=60) Outcome Number (%) Seizure-free at 6 months 54 (90) Recurrence of seizure 6 (10) Complete lesion resolution 51 (85) Partial lesion reduction 9 (15) Complications 0 (0)

This study aimed to evaluate the clinical and radiological characteristics of patients presenting with seizures and superficial solitary enhancing CT lesions. Our findings highlight the importance of these lesions, particularly in regions endemic for neurocysticercosis, as a leading cause of new-onset seizures. Clinical Presentation and Seizure Characteristics The majority of patients were young adults with a slight male predominance, consistent with previous studies reporting higher incidence of seizures in this demographic [1,2,3]. Focal-onset seizures were the most common presentation, aligning with the cortical or subcortical localization of lesions. This finding corroborates previous reports that solitary enhancing CT lesions, particularly cysticercal granulomas, often present with focal seizures [4,5]. Generalized seizures were less frequent, consistent with observations that superficial lesions tend to generate localized epileptogenic foci [6]. Radiological Findings Radiologically, the parietal lobe was the most frequently involved site, followed by frontal and temporal lobes. Lesion size was mostly <15 mm, with ring or nodular enhancement patterns. These features are typical of solitary cysticercus granulomas (SCG) [1,3,7]. Mild perilesional edema was noted in 30% of patients, similar to previous studies suggesting that edema does not significantly impact seizure prognosis [4,8]. Treatment and Outcomes All patients received standard antiepileptic therapy, while 50% were treated with albendazole. Seizure control was achieved in 90% of patients, and 85% demonstrated complete lesion resolution on follow-up imaging. These results are consistent with earlier studies indicating a favorable prognosis for patients with solitary enhancing lesions when managed appropriately [4,7,9,10]. Clinical Implications The presence of superficial solitary enhancing lesions in patients with new-onset seizures should prompt consideration of neurocysticercosis, particularly in endemic regions. Early recognition and timely initiation of antiepileptic and antiparasitic therapy can result in rapid seizure control and lesion resolution, minimizing prolonged therapy [1,4,10]. Differentiation from other etiologies, such as abscesses, tumors, or metastases, remains critical for appropriate management [11]. Limitations and Future Directions The study is limited by its relatively small sample size and short follow-up duration. Histopathological confirmation was not obtained in all cases, which could have strengthened diagnostic accuracy. Future studies with larger cohorts, longer follow-up, and advanced imaging or biopsy correlation are needed to optimize management and better understand seizure recurrence patterns in these patients [5,9,12].

1.Del Brutto OH. Neurocysticercosis. Lancet. 2012;380(9840):1870–82. 2.Prasad KN, Gupta RK, Jaiswal AK, et al. Solitary cysticercus granuloma: a common cause of new-onset seizures in India. Neurol India. 2000;48(3):251–5. 3.Garg RK, Kar AM, Tripathi M. Seizures in patients with solitary enhancing CT lesions. Neurol Asia. 2001;6:91–6. 4.Mathur A, Misra S, Gupta V, et al. Outcome of seizure disorder in patients with solitary cerebral cysticercus granuloma. Seizure. 2003;12(7):457–61. 5.Singh G, Prabhakar S, Choudhary A, et al. Clinical and radiological profile of solitary enhancing lesions causing seizures. Neurol India. 2005;53(4):450–4. 6.Ranjan P, Agarwal A, Misra UK. Epileptogenic potential of cortical neurocysticercosis lesions. Seizure. 2006;15(7):478–84. 7.Bhattacharyya KB, Das SK, Chatterjee S. Outcome of patients with solitary cerebral cysticercus granuloma. Indian J Med Res. 2008;127(3):280–5. 8.Garg RK, Kar AK, Malhotra HS. Cortical lesions and seizure recurrence: a prospective follow-up study. Neurol India. 2011;59:459–63. 9.Tripathi M, Prabhakar S, Ranjan P. Seizure outcome in patients with solitary neurocysticercosis lesions. Seizure. 2007;16(3):224–9. 10.Renganathan V, Sundaralingam M, et al. Long-term seizure outcome in patients with solitary cysticercal granulomas. Epilepsy Res. 2010;90:79–84. 11.Gupta RK, Jena A, Verma R. Differential diagnosis of ring-enhancing brain lesions: CT and MRI correlation. Neurol India. 2009;57:550–6. 12.Kumar R, Mahapatra AK, Garg RK. Solitary enhancing lesions in neurocysticercosis: a histopathological correlation study. J Neurol Sci. 2012;316:56–61.