Parenchymatous cerebral neurocysticercosis in a quadriplegic patient

Abstract

Objective: To present and discuss a case of cerebral neurocysticercosis in a quadriplegic patient. Design: Case report of a case of neurocysticercosis in a high level spinal cord injury (SCI) patient who developed episodes of autonomic dysre¯exia and orthostatic hypotension associated with transient neurologic de®cits and seizures. Setting: Spinal Cord Unit of the University Hospital of Geneva, Switzerland. Subject: Single patient case report. Main outcome measure: Clinical and radiological magnetic resonance imaging follow-up of the patient between July 1995 and October 1997. Results: Treatment of cysticercosis with praziquantel relieved the patient from autonomic dysre¯exia, symptomatic orthostatic hypotension, transitory neurological de®cits and seizures. Conclusion: Diagnosis of neurocysticercosis in a quadriplegic patient might be dicult because of frequent overlaps with some usual symptoms occurring in high level SCI, mostly autonomic dysre¯exia and orthostatic hypotension. Neurocysticercosis should be kept in mind when a SCI patient living in, or coming from endemic zones presents with new neurological abnormalities and seizures. Magnetic resonance imaging appears to be more sensitive than computerised tomography to con®rm the diagnosis of active cysticercosis. Treatment with praziquantel associated with cimetidine to increase the drug bioavailability and prednisone to reduce the in¯ammatory reaction gives good results.