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Exposure to Taenia solium through fecal contamination of food
Focal central nervous system (CNS) lesions; seizures, headache
Brain imaging shows cysts; positive serologic tests
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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
Spinal cord lesions can present with progressive focal findings
Cysticercosis of organ systems other than the CNS is usually benign
Involvement of muscles can cause discomfort (uncommon)
Subcutaneous involvement presents with multiple painless palpable skin lesions
Involvement of the eyes can present with ptosis due to extraocular muscle involvement or intraocular abnormalities
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Cerebrospinal fluid examination may show
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
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Benefits of cyst clearance in neurocysticercosis must be weighed against potential harm of an inflammatory response to dying worms
Most authorities recommend treatment of active lesions, in particular lesions with a high likelihood of progression, such as intraventricular cysts; conversely, inactive calcified lesions probably do not benefit from therapy
Cysticidal therapy should be avoided if there is a high risk of hydrocephalus, as with subarachnoid involvement
When treatment is deemed appropriate, standard therapy consists of albendazole (preferred; 10–15 mg/kg/d orally for 8 days) or praziquantel (50 mg/kg/d orally for 15–30 days)
Combining albendazole plus praziquantel improved outcomes compared with albendazole alone in patients with multiple viable intraparenchymal cysts
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