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What is the problem with my son's head?

Q: In sunlight, my 14 years old son’s eyes start watering. This has been happening for six motnhs. A few days back, his right eye developed an infection. The doctor gave him Citregen and eye drops but after some days the same thing recurred and we gave him the same treatment. Then he started having headache on just one side of his head and hence CT scan and MRI were done. The report revealed a well-defined rounded lesion in the right frontal lobe cortex likely to be an inflammatory granuloma/ neurocysticercosis. The blood report states cysticercus IgG - 2.06, TB feron indeterminate not detected. The doctor prescribed Zental. After a month another MRI was done but no change was found. So, the treatment for tuberculomas was started for a month. He got no fits during the treatment period but 5 months back he got fits twice. The doctor says that the medicines may have been skipped. Is the treatment appropriate? Last month's MRI reported discrete peripheral enhancing lesion in the right frontal lobe with an irregular peripheral enhancing rim with moderate perilesional oedema leading to effacement of adjoining subarachnoid spaces. Please advise.

A:Your note suggests that the doctor treating the patient is relying on the scans and blood findings. The abnormal area of the brain has not been operated upon and we have no microscopic examination of the diseased tissue. In many instances it is possible to make an educated guess of the nature of the disease in the brain without surgery and treat successfully with drugs. Cysticercosis (a parasitic disease) and infection by the germ causing tuberculosis are two examples. It appears that the doctor initially treated the disease as cysticercosis and since the response was not adequate, revised his diagnosis and has started treatment for tuberculosis. The presence of swelling around the diseased area in the brain in the last month's scan suggests that the disease remains active despite anti-tuberculosis drug therapy for three months or so. You should discuss this matter again with the doctor and ask for an opinion on whether the disease is worsening. If it is, it may be wiser to do an operation, remove the diseased tissue and subject it to microscopic examinations and other relevant tests. This will yield a definitive diagnosis on the basis of which accurate therapy can be prescribed.


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