Differential Diagnosis for Ring Lesion in Brain
- Single most likely diagnosis
- Brain abscess: This is a common cause of ring-enhancing lesions in the brain, particularly in immunocompromised patients or those with a history of trauma or infection. The ring enhancement is due to the body's attempt to wall off the abscess.
- Other Likely diagnoses
- Glioblastoma: A type of brain tumor that can present with a ring-enhancing pattern on imaging, due to central necrosis surrounded by viable tumor.
- Metastatic brain tumor: Similar to glioblastoma, metastatic lesions can also exhibit ring enhancement, especially if they outgrow their blood supply and undergo central necrosis.
- Demyelinating disease (e.g., multiple sclerosis): While not typically ring-enhancing, some forms of demyelinating disease can present with ring-like lesions, particularly in the context of tunefractive demyelination.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cerebral toxoplasmosis: Especially in immunocompromised patients, toxoplasmosis can cause ring-enhancing lesions that are indistinguishable from other etiologies without appropriate testing.
- Neurocysticercosis: A parasitic infection that can cause ring-enhancing lesions, particularly in endemic areas or in patients with a history of travel to such areas.
- Primary central nervous system lymphoma (PCNSL): Can present with ring enhancement, although this is less common than other patterns of enhancement.
- Rare diagnoses
- Subacute infarction: In some cases, subacute infarcts can exhibit ring enhancement due to luxury perfusion and breakdown of the blood-brain barrier.
- Radiation necrosis: A complication of radiation therapy that can cause ring-enhancing lesions due to damage to the brain tissue and blood vessels.
- Fungal infections (e.g., aspergillosis, cryptococcosis): These can cause ring-enhancing lesions, particularly in immunocompromised patients, although they are less common than other etiologies.