The purpose of this study was to describe the natural history of untreated cysticercosis as monitored by cranial computed tomography (CT) and correlate it when possible with the pathologic stage of the disease noted at surgery. Serial CT was performed in 113 patients; two to four scans were obtained in each patient. Correlation with surgical specimens and clinical presentation is given. In the early, acute stage, focal nonenhancing areas of edema progress to homogeneously enhancing lesions. In the chronic phase, beginning a few months after infestation, nonenhancing cysts are seen, which later demonstrate ring enhancement. Lesions may then completely resolve or may resolve only to appear later as punctate calcifications. This radiologic progression suggests the need to reevaluate current concepts in therapy and diagnosis of this disorder. Studies on therapeutic efficacy should be based on both the improvement of clinical symptoms and evidence of lesion regression at CT.

A review was made of the clinical records and radiographic examinations of 38 patients with neck lesions clinically suspected of being branchial cleft anomalies. The impact of computed tomography in this sometimes confusing clinical picture was assessed and CT criteria for diagnosing branchial cleft anomalies (BCAs) and differentiating them from their mimics were identified. Seventeen branchial cleft anomalies (four of the first branchial cleft and 13 of the second branchial cleft) and 21 BCA mimics were evaluated. A definitive CT diagnosis of second branchial cleft cysts based on characteristic morphology, location, and displacement of surrounding structures was possible in 80% of cases. CT was found to be the best radiographic examination in making a definitive diagnosis of BCA if a neck mass was present. CT-derived information, by providing additional preoperative data on the extent and type of neck lesion, frequently altered the course of patient management.

Baylisascaris procyonis, the common raccoon roundworm, is a rare cause of devastating or fatal neural larva migrans in infants and young children. We describe the clinical features of two children from suburban Chicago who developed severe, nonfatal B. procyonis neural larva migrans. Despite treatment with albendazole and high dose corticosteroids, both patients are neurologically devastated. In many regions of North America, large populations of raccoons with high rates of endemic B. procyonis infection live in proximity to humans, which suggests that the risk of human infection is probably substantial. In the absence of effective treatment, prevention of infection remains the most important public health strategy.