Cysticercosis

Exposure to Taenia solium through fecal contamination of food

Focal CNS lesions; seizures, headache

Brain imaging shows cysts; positive serologic tests

Presenting symptoms include seizures, focal neurologic deficits, altered cognition, and psychiatric disease

Symptoms develop more quickly with intraventricular cysts, with findings of hydrocephalus and meningeal irritation, including

• Severe headache

• Vomiting

• Papilledema

• Visual loss

Neurocysticercosis

• Can cause intracerebral, subarachnoid, and spinal cord lesions and intraventricular cysts

• Single or multiple lesions may be present

• Lesions may persist for years before symptoms develop, generally due to local inflammation or ventricular obstruction

Racemose cysticercosis

• A particularly aggressive form of the disease

• Involves proliferation of cysts at the base of the brain, leading to alterations of consciousness and death

Cerebrospinal fluid examination may show

• Lymphocytic or eosinophilic pleocytosis

• Decreased glucose

• Elevated protein

Enzyme-linked immunosorbent assay (ELISA) and related immunoblot assays have excellent sensitivity and specificity, but sensitivity is lower with only single or calcified lesions

Performing both CT and MRI is ideal

• CT is better for identification of calcification

• MRI is better for smaller and ventricular lesions

Benefits of cyst clearance must be weighed against potential harm of an inflammatory response to dying worms

When treatment is deemed appropriate, standard therapy consists of albendazole (10–15 mg/kg/day orally for 8 days) or praziquantel (50 mg/kg/day orally for 15–30 days)

Corticosteroids are usually administered concurrently, but dosing is not standardized

Anticonvulsant therapy should be provided (if needed) and shunting performed (if required) for elevated intracranial pressure

Surgical removal of cysts may be helpful for some difficult cases of neurocysticercosis and for symptomatic non-neurologic disease