Most common parasitic infection of the CNS.
The most common helminthic infection of the CNS and major cause of seizures and hydrocephalus.
Caused by tissue invading larval forms of the pork tapeworm Taenia sodium.
Infection more common from Latin America, Asia, and Africa.
Increasing incidence in US.
The infection is transmitted via ingestion of Taenia solium eggs and spreads to the CNS from the stomach by way of vascular and lymphatic channels.
In SW California neurocysticercosis may account for 10% of emergency department visits.
Larvae can be deposited in brain parenchyma and spinal cord.
And immune response to the cyst, which has a Terminal lifespan, results in cerebral edema and associated symptoms.
Focal seizures are the most common neurologic manifestation.
Neurologic symptoms include seizures, intracranial hypertension, and focal neurologic signs when encysted worms die in the body mounts an associated inflammatory response.
Intraparenchymal disease is the most common form, however 10-20% of patients present with intraventricular cysterci.
Patients with intraventricular disease have rapid clinical deterioration, as a result of hydrocephalus, including sudden deaths.
Patients may be asymptomatic.
Patients can manifest disease several years after original exposure.
The disease can be transmitted both by direct human-to-human contact and indirectly by contaminated water of food.
Imaging may show nonenhancing hypodense lesions, edema, calcifications, or hydrocephalus.
Finding a scolex within the cyst is pathognomonic for neurocysticercosis.
Neuroimaging may be nonspecific findings.
Diagnosis is made using clinical presentation findings,, imaging studies, serology and epidemiologic data.
MRI of the brain has a sensitivity that is superior to CT, as well as to funduscopic examination to rule out ocular disease.
The diagnosis can be confirmed by enzyme-linked immuno transfer blot, which detects serum antibodies to T solium with asensitivity of 86%, and nearly 100% of patients with intraventricular lesions.
Treatment consists of anticonvulsants, antihelminthic therapy with albendazole or praziquantel and corticosteroids.
Surgery is reserved for hydrocephalus or giant cysts with intracranial hypertension.
Asymptomatic patients require no therapy.
