Fourth ventricular neurocystercercosis presenting with acute hydrocephalus

Cervicomedullary neurocysticercosis causing obstructive hydrocephalus

“…A simple hydraulic maneuver by placing the patient in the Trendelenburg position intraoperatively can facilitate the endoscopic en bloc removal of third ventricular neurocysticercosis [20]. Cysts in the fourth ventricle can by removed from a posterior approach, either with neuroendoscopy or microdissection [17,[21][22][23][24]. This has been described in several case series with successful treatment of hydrocephalus without the need for permanent CSF diversion.…”

Pathogenesis ofTaenia soliumtaeniasis and cysticercosis

“…Direct obstruction of CSF circulation by the parasite per se is also an important cause of hydrocephalus in NCC. In patients with ventricular cysts, these may directly occlude the foramens of Monro, Luschka, Magendie and the cerebral aqueduct . A particularly common form of intracranial hypertension in NCC is Brun's syndrome, characterized by the abrupt onset of symptoms associated with brisk changes in the position of the head, following the obstruction of the CSF flow through the cerebral aqueduct by freely floating cysts in the IVth ventricle .…”

Uncommon Clinical Manifestations of Cysticercosis

“…Clinical and imagenological aspects on FVNCC has been described in the medical literature [99][100][101][102][103][104][105][106][107][108] and can be sumarized as follow: Symptoms and sings of intracraneal hypertension due to obstructive hydrocephalus [99,[100][101][102][103][104][105][106][107] , blurred vision, loss of consciousness, [100] sudden death, [108] reversible parkinsonism following ventriculoperitoneal shunt, [109] Bruns syndrome, [110] positional vomiting [111] and comatose state [112] From the point of view of imagenology, the magnetic resonance imaging (MRI) is the investigation of choice which can also show: cerebrospinal fluid (CSF) signal intensity (on all pulse sequences), intra fourth ventricular cyst with scolex, and wall enhancement. On T1-weighted and Fluid Attenuation Inversion Recovery images (FAIR), the cyst wall and scolex which are not seen in other routine sequences, and the CSF flow study can show the intraluminal nature of the cyst [113] and the even imagenological appearance of multicystic tumor.…”

“…[114] Most studies have been addressed to review the therapeutic approaches of IVNCC, as can be seen in our review. [99,110,[115][116][117][118][119][120][121][122][123][124][125][126][127] and has been well established that available treatment options are: medical, external cerebro-spinal fluid diversion, microsurgical, or endoscopic removal alone or in combination. [122] Summarizing the reports in the medical literature we can conclude that the best choices for treatment of IVNCC are:…”

“…Endoscopy approach: Neuroendoscopy provides a safe and effective management modality for the treatment of a variety of intracranial disorders, either temporal or nontumoral, congenital, developmental, and degenerative, and its knowledge, indications, and limits are fundamental for the armamentarium of the modern neurosurgeon. [126] In patients presenting symptomatic obstructive hydrocephalus, aqueductal and foramen of Monro dilatations, endoscopic neurosurgery is a minimally invasive technique enabling removal of intraventricular cyticercal cysts from all locations, avoiding major craniotomies/posterior fossa explorations and shunts. The flexible fiberoptic scope is used for excising cysts in the fourth ventricle, through a transaqueductal route and patients should be treated with albendazole in the postoperative period.…”