Case of the Month
Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO
November 2021
Next Case of the Month Coming December 7...
Racemose Neurocysticercosis
- Background:
- Neurocysticercosis (NCC) is the most common parasitic infection of the brain caused by encysted larval stage of the pork tapeworm Taenia solium.
- In the CNS, cysticerci can present as parenchymal, or in a rarer extraparenchymal form, as racemose, cysts in the subarachnoid spaces, ventricles, and basal cisterns.
- Clinical Presentation:
- Can be varied
- Racemose neurocysticercosis usually presents as a meningeal, intraventricular, or subarachnoid (cisternal) form. In the racemose form, the patient usually presents with raised intracranial pressure, meningitis, and hydrocephalus. It may cause vasculitis and entrapment of the cranial nerves, resulting in a focal neurologic deficit.
- Our patient presented with an unusual history of involuntary movements.
- Key Diagnostic Features:
- CT and MRI are useful in diagnosis.
- The cysts are usually larger than in the parenchymal forms and have a multilocular appearance, tend to displace neighboring structures, and behave as lesions with a mass effect.
- The signal intensity is similar to that of the cerebrospinal fluid.
- Normally do not show significant contrast enhancement; may show peripheral enhancement
- Cysticerci usually do not contain scolices. If a scolex is seen, it is almost diagnostic/pathognomonic.
- Differential Diagnoses:
- Arachnoid cysts
- Porencephaly
- Hydatid disease
- Cystic astrocytoma
- Colloid cyst of third ventricle
- Treatment:
- ​Praziquantel and albendazole are cysticidal drugs that are effective in the treatment of all forms of neurocysticercosis. Cysticidal drugs are applied for longer when treating large cysts and subarachnoid cysts than when treating parenchymal neurocysticercosis. The disappearance of these cysts with cysticidal drug therapy has been reported. The administration of albendazole at a higher dose (30 mg/kg/day) than usual has been found to increase the clearance of intraventricular and subarachnoid cysts.
- A ventriculoperitoneal shunt may be needed in patients with significant obstructive hydrocephalus.
- Our patient showed significant reduction in the cysts after albendazole treatment for a period of 4 weeks. She also had significant clinical improvement, with resolution of the involuntary movements.
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