Ischaemic stroke induced by neurocysticerosis, presenting as a clinical and radiological dilemma

Abstract

Neurocysticercosis (NCC) is a central nervous system parasitic infection with various clinical presentations, rarely manifesting as an acute stroke. The radiological appearance of this disease entity may be non-specific, at times mimicking an intracranial neoplasm. Early diagnosis requires a high index of suspicion. Serological testing is helpful and, if utilized early, can reduce the morbidity associated with invasive diagnostic techniques. We describe a case of a 32-year-old previously healthy male who presented with neurological deficits. A cystic lesion in the right sylvian cistern was noted, initially identified as a benign arachnoid cyst. The patient's symptoms rapidly progressed to an acute stroke. Follow-up imaging including an MRI of the brain demonstrated a right middle cerebral artery territory infarct adjacent to the cystic lesion, which had been diagnosed as an arachnoid cyst on an initial CT scan. Appearance of the cystic lesion on MRI, however, was concerning for a brain neoplasm or an abscess. Given the contiguity of the cystic mass to the right middle cerebral artery, it was suggested that the mass was the likely aetiology of the patient's symptoms. A stereotactic biopsy of the cystic lesion was performed and revealed it to be NCC. The hospital course was complicated by intracranial hypertension and cerebral oedema requiring craniectomy. Our case highlights the importance of considering NCC in the differential diagnosis of stroke in patients coming from endemic regions, especially in younger patients lacking the usual risk factors for cerebrovascular disease.

Concurrent Extraparenchymal and Spinal Neurocysticercosis in an Immunocompetent Patient Treated for Obstructive Hydrocephalus and Spinal Cord Compression

“…[32] The intraparenchymal presentation is characterized by embryos forming cysts within the brain parenchyma, which may lead to seizures, chronic headaches, or in some cases focal neurologic deficits. [29,43] In extraparenchymal cases, cysts are located within the cerebral ventricles, subarachnoid space, or within the spine. [32,43] Extraparenchymal NCC involving the subarachnoid space primarily present with symptoms of intracranial hypertension, with some reported cases of hydrocephalus, as well as stroke.…”

“…[32,43] Extraparenchymal NCC involving the subarachnoid space primarily present with symptoms of intracranial hypertension, with some reported cases of hydrocephalus, as well as stroke. [23][24][25][26][27][28][29] Spinal NCC can occur when cysts are located within the subarachnoid space or within the parenchyma of the spinal cord proper. The most common clinical presentations of spinal NCC are myelopathy and progressive weakness caused by cord compression, though this may differ depending on relevant spinal levels.…”