Neurocysticercosis Involving the Pituitary Stalk : Case Report and Literature Review

Abstract

J Korean Neurosurg Soc 48 : [91][92][93] 2010 Neurocysticercosis (NCC) is the most common parasitic infestation of the central nervous system. Most cases of NCC are to related and/or associated with inflammation within the cerebral parenchyma. A 71-year-old woman presented with a 4-year history of visual disturbance. This symptom had become aggravated 4 weeks earlier. Her visual acuity gradually decreased and superior hemianopsia was noted. Magnetic resonance imaging (MRI) revealed an enhanced and thickened pituitary stalk accompanying a suspicious mass. The provisional diagnoses were lymphoma, glioma, or other inflammatory conditions. Laboratory studies, including blood and hormonal studies, showed normal findings. Surgical resection was performed. In the pathological examination, degenerated parasitic wall structure was seen and its contents were composed of completely degenerated focal globular structures suggesting the scolex of cysticercus. We report an unusual case of NCC involving the pituitary stalk which was presented with a juxtasellar tumor. The possible underlying mechanisms are discussed with a review of pertinent literature.

Intrasellar cysticercosis cyst treated with a transciliary supraorbital keyhole approach – A case report

“…The case we present had a campimetric deficit as the main clinical presentation caused by chiasmatic compression secondary to an intrasellar cyst. This clinical manifestation has been reported in the revised bibliography in very few cases,[ 3 , 8 ] having hormonal disturbances as the main clinical deficit within this location,[ 6 , 7 , 9 , 13 ] as well headache, loss of visual acuity, blindness, and even exophthalmos. [ 5 ] In endemic areas, every patient with a chiasmatic syndrome and hormonal disturbances, NCC needs to be rule out.…”

“…The extraparenchymal form that accounts for 15–30% of the cases has variable clinical manifestations including intracranial hypertension, cranial nerve abnormalities, and hydrocephalus. [ 11 , 17 ] Sellar NCC was also eventually recognized in autopsy series of patients with NCC,[ 3 , 5 ] increased awareness of intrasellar NCC only came after the introduction of modern neuroimaging diagnostic methods. In 1985 and 1988, the first series of eight patients with intrasellar cysticercosis was reported from Mexico City.…”

Neurocysticercosis: A Rare Cause of Occipital Lobe Epilepsy

“…The larvae enter into the body by the ingestion of taenia solium eggs in fecally contaminated food or water. After ingestion, the eggs hatch in the duodenum and release larvae that can penetrate intestinal mucosa and enter the circulatory system, by which they localize as cysts within the skeletal muscles, eyes, or brain (1) . When a larva is detected in the nervous system, this clinical manifestation is named as neurocysticercosis, which is the most common helminthic infection of the central nervous system (3) .…”

“…The larval form of taenia solium enters into the body by ingestion of the eggs of the parasite in the focally contaminated food or water. The larvae can penetrate the intestinal mucosa and enter the circulatory system, by which they reach to and localize within the skeletal muscles, eyes, or brain as cystic form (1) . Although the first mode of treatment in neurocysticercosis is antihelmintic theraphy with preventive theraphy for epileptic seizures and perifocal edema, surgery should also be considered in selected patients who have a discrete lesion and intractable epilepsy.…”

Uncommon Clinical Manifestations of Cysticercosis

“…Other authors have similar opinions. [210,[213][214][215][216] Although NCC damages sellar structures with direct compression by large cysts, extension through the basal cisterns and third ventricle with focal arachnoiditis can result as an inflammatory response. Taking into consideration that the sellar region and the basal cisterns contain many vascular and CNS structures that are separated by only a few millimeters increasing the possibility that different pathologic entities could affect them simultaneously then analysis of imaging findings and knowledge of the varied clinical presentations of NCC are important to detect cases of sellar involvement in patients with unexplained visual loss or atypical cystic lesions in the sella, especially in endemic countries.…”