Neuroimaging Cases 009

Neurocysticercosis

Over the past two years we have created neuroimaging presentations which we will continue to add to. Today we present the second in our Neuroimaging Case Studies Series in which we share a clinical case, brief literature review, and concise summary recommendations.

Images, text and cases collated by Troy Carnwath MD, Teresa Crow MD, L. Erin Miller MD, Scott DiMeo MD, and Natalie Rall MD. We were especially fortunate to have Drs. Michael Leonard and David Weinrib serving as Guest Editors for the presentation. First published on EMGuideWire.com and peer reviewed by Professor Michael Gibbs.

Summary

• Neurocysticercosis (NCC) is a central nervous system infection caused by the larval stage of the pork tapeworm Taenia solium
• Cysts lodged in different compartments of the brain give rise to unique clinical syndromes that require specific treatments.
• Parenchyma cysts typical manifest with seizures
• Extraparenchymal cysts typically manifest with signs and symptoms due to hydrocephalus
• CT + MRI are the imaging studies of choice to fully characterize NCC
• Serologic testing with enzyme-linked immunotransfer blot as a confirmatory test in patients with suspected neurocysticercosis

Treatment

• Patients presenting with seizures should receive antiseizure medications
• There is no clear data on a preferred antiseizure agent
• Patients presenting with hydrocephalus should have neurosurgical treatment and steroids before antiparasitic therapies are initiated
• Because antiparasitic therapies worsen edema around brain cysts, steroid therapy should be initiated before these are initiated
• Consultation with Infectious Disease, Neurology, and Neurosurgery (as needed) will provide optimal multidisciplinary care 

References

General

• Pineda-Reyes R, White AC Jr. Neurocysticercosis: an update on diagnosis, treatment, and prevention. Curr Opin Infect Dis. 2022 Jun 1;35(3):246-254.
• White AC Jr, Coyle CM, Rajshekhar V, Singh G, Hauser WA, Mohanty A, Garcia HH, Nash TE. Diagnosis and Treatment of Neurocysticercosis: 2017 Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis. 2018 Apr 3;66(8):e49-e75.
• Schantz PM, Moore AC, Muñoz JL, Hartman BJ, Schaefer JA, Aron AM, Persaud D, Sarti E, Wilson M, Flisser A. Neurocysticercosis in an Orthodox Jewish community in New York City. N Engl J Med. 1992 Sep 3;327(10):692-5.
• Berto C, Coyle C. Revenge of the Cyst. Febrile Podcast
• Beech G. CT Case 033. LITFL
• WHO guidelines on management of Taenia solium neurocysticercosis

Endoscopic Treatment

• Torres-Corzo JG, Tapia-Pérez JH, Vecchia RR, Chalita-Williams JC, Sánchez-Aguilar M, Sánchez-Rodríguez JJ. Endoscopic management of hydrocephalus due to neurocysticercosis. Clin Neurol Neurosurg. 2010 Jan;112(1):11-6
• Kaif M, Husain M, Ojha BK. Endoscopic Management of Intraventricular Neurocysticercosis. Turk Neurosurg. 2019;29(1):59-65.
• Sharma BS, Sawarkar DP, Verma SK. Endoscopic Management of Fourth Ventricle Neurocysticercosis: Description of the New Technique in a Case Series of 5 Cases and Review of the Literature. World Neurosurg. 2019 Feb;122:e647-e654.
• Yadav YR, Bajaj J, Ratre S, Yadav N, Parihar V, Swamy N, Kumar A, Hedaoo K, Sinha M. Endoscopic Third Ventriculostomy – A Review. Neurol India. 2021 Nov-Dec;69(Supplement):S502-S513.

This neuroimaging interpretation series is proudly sponsored by the Emergency Medicine Residency Program at Carolinas Medical Center. The goal is to promote widespread mastery of CXR interpretation. There is no personal health information [PHI] within, and ages have been changed to protect patient confidentiality.