Case Report MRS Findings in Cerebral Coenurosis due to Taenia Multiceps Sudheer Ambekar, MBBS, Chandrajit Prasad, DM, Srinivas Dwarakanath, MCh, Anitha Mahadevan, MD From the Departments of Neurosurgery (SA, SD); Neuroimaging and Interventional Radiology (PC); and Neuropathology (AM), National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India. Keywords: Taenia multiceps, cerebral coenurosis, magnetic resonance spec- troscopy (MRS), pyruvate, acetate. Acceptance: Received September 18, 2010, and in revised form March 13, 2011. Accepted for publication March 13, 2011. Correspondence: Address correspon- dence to Dr Chandrajit Prasad, As- sistant Professor, Department of Neu- roimaging and Interventional Radiology, NIMHANS, Bangalore, India. E-mail: chandrajitt2@gmail.com. J Neuroimaging 2011;XX:1-3. DOI: 10.1111/j.1552-6569.2011.00616.x ABSTRACT Cerebral coenurosis due to Taenia multiceps is a rare infection with no case reports from India. A 55-year-old male patient had presented with progressive symptoms of hemi- paresis of 1-year duration. Magnetic resonance imaging (MRI) with magnetic resonance spectroscopy (MRS) of the lesion was performed that showed a septated cystic lesion in left parieto-occipital lobe. Multivoxel MRS through the lesion was performed using repetition time of 1500 ms and time to echo of 144 ms at 3T MRI. MRS showed mildly elevated choline (Cho), depressed creatine (Cr), and N-acetyl aspartate (NAA), a large peak of lactate, pyruvate, and acetate peaks. To best of our knowledge, there has been no reported case of in vivo proton MRS finding ever reported. We present MRS findings in this operatively proven case of T. multiceps cyst of the brain. Introduction The differential diagnosis of nonenhancing cystic intracranial brain lesions is extensive even with the aid of sophisticated imaging techniques. 1 The neuroimaging findings may not be useful in characterizing these lesions with certainty but can nar- row down the differential diagnosis. This is particularly true in case of extremely rare lesions, such as coenurosis. Proton magnetic resonance spectroscopy (MRS) serves as an adjunct to identify the nature of some cerebral lesions but still there is con- siderable overlap of findings with other conditions. Proton MRS provides a noninvasive method for examining a wide variety of metabolites in the human brain, including N-acetylaspartate (NAA), choline (Cho), creatine (Cr), lactate (Lac), lipids, and others such as succinate, pyruvate, aminoacids, acetate, glycine, glutamine/glutamate, and inositol. 3-5 Case Report A 55-year-old man presented to neurosurgical services of our hospital with complaints of gradually progressive left hemipare- sis over a year. This was associated with reduced sensory per- ception over left half of the body. He complained of reduced visual perception on the left side since 2 months associated with headache. No history of fever or seizures was present. Neu- rological examination revealed left-sided hemiparesis (MRC grade 3/5) with hemisensory loss and left-sided homonymous hemianopia. Magnetic resonance imaging (MRI) showed a sep- tated cystic lesion in the left parietal lobe without any perile- sional edema. We performed proton MRS through the margin of the lesion using multivoxel 2D PRESS technique using the following parameters: repetition time (TR) = 1500 ms, time to echo (TE) = 144 ms with NSA = 1 at 3T MRI that uses auto- mated correction techniques (high-pass filters and apodization). Choline peak at 3.2 parts per million (ppm) was increased, the choline/creatine (Cho/Cr ratio being 1.64. An NAA peak at 2 ppm was also depressed, the NAA/Cr ratio being 0.85. In addition, a large inverted bifid lactate peak, and small peaks at 1.9 and 2.4 ppm were observed, presumed to be acetate and succinate peaks (Fig 1). At surgery, the lesion was found to have a poorly defined pericyst and well-defined flimsy whitish ectocyst with clear wa- tery contents. The cyst was completely excised. Along the lat- eral aspect of the cyst, small daughter cyst with small whitish scolices was seen. Postoperatively the patient improved and was discharged on a 2-week course of albendazole. At follow- up after 2 months, his power had improved to 5/5. Histo- logical examination of the lesion revealed a cyst with well- defined thick cuticle with numerous microvillous projections along the inner aspect invaginating to form multiple scol- ices in varying stages of degeneration with hydropic change and calcification. Adjacent parenchyma showed inflammation and gliosis walling off the lesion. The histological features were characteristic of cerebral coenurosis caused by Taenia multiceps . Copyright ◦ C 2011 by the American Society of Neuroimaging 1