The differential diagnosis of the “dot-in-hole” sign on brain imaging, or an intracranial cyst containing an eccentric hyperintense nodule, includes cryptococcal meningoencephalitis. However, when the finding is visible on noncontrast brain MRI, neurocysticercosis should be considered as the dot represents the scolex (anterior end) of the Taenia solium. Although serologic testing is available for suspected cases, identifying the scolex alone is sufficient to confirm the diagnosis. To avoid a sticky predicament, once viable parenchymal neurocysticercosis is confirmed, clinicians should remember to evaluate for ocular taeniasis, latent tuberculosis, and strongyloidiasis before starting antiparasitic therapy and adjunctive corticosteroi…
Comment
The differential diagnosis of the “dot-in-hole” sign on brain imaging, or an intracranial cyst containing an eccentric hyperintense nodule, includes cryptococcal meningoencephalitis. However, when the finding is visible on noncontrast brain MRI, neurocysticercosis should be considered as the dot represents the scolex (anterior end) of the Taenia solium. Although serologic testing is available for suspected cases, identifying the scolex alone is sufficient to confirm the diagnosis. To avoid a sticky predicament, once viable parenchymal neurocysticercosis is confirmed, clinicians should remember to evaluate for ocular taeniasis, latent tuberculosis, and strongyloidiasis before starting antiparasitic therapy and adjunctive corticosteroi…