Cysticercosis

Key Features

• Exposure to Taenia solium through fecal contamination of food

• Focal CNS lesions; seizures, headache

• Brain imaging shows cysts; positive serologic tests

Clinical Findings

• 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

Diagnosis

• 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

Treatment

• 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

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