Subarachnoid neurocysticercosis: emerging concepts and treatment

Abstract

Purpose of review: Subarachnoid neurocysticercosis (SUBNCC) is due to a morphologically unique proliferative form of Taenia solium involving the subarachnoid spaces. Prolonged therapy based upon the pathophysiology of SUBNCC and long-term follow-up have shed light on the course of disease and led to highly improved outcomes.Recent findings: SUBNCC has a prolonged incubation period of between 10-25 years characterized by cyst proliferation and growth and invasion of contiguous spaces leading to mass effect(Stage 1). With induction of the host immune responses cysts degenerate leading to a predominately inflammatory arachnoiditis(Stage 2) causing hydrocephalus, infarcts and other inflammatory based neurological manifestations. Inactive disease(Stage 3) may occur naturally but mostly is a result of successful treatment, which generally requires prolonged intensive anthelminthic and anti-inflammatory treatments. CSF cestode antigen or cestode DNA falling to non-detectable levels predicts effective treatment. Prolonged treatment with extended follow-up has resulted in moderate disability and no mortality. Repeated short intensive 8-14-day courses of treatment are also used, but long-term outcomes and safety using this strategy are not reported.Summary: SUBNCC gives rise to a chronic arachnoiditis. Its unique ability to proliferate and induce inflammatory responses requires long-term anthelmintic and anti-inflammatory medications.

Spinal arachnoiditis and syringomyelia: Review of literature with emphasis on postinfectious inflammation and treatment

“…A review of literature suggests a number of different infectious agents to be involved in causing arachnoiditis including Mycobacterium tuberculosis, Cryptococcus, Coccidioides, Taenia solium (neurocysticercosis), and Histoplasma to name a few. [ 4 , 5 , 24 , 25 , 27 ] Of these pathogens, tuberculosis appears to be significantly associated in patients having a positive HIV status. [ 1 , 28 ]…”

“…[9] A review of literature suggests a number of different infectious agents to be involved in causing arachnoiditis including Mycobacterium tuberculosis, Cryptococcus, Coccidioides, Taenia solium (neurocysticercosis), and Histoplasma to name a few. [4,5,24,25,27] Of these pathogens, tuberculosis appears to be significantly associated in patients having a positive HIV status. [1,28] Clinical arachnoiditis presents very similarly to other diseases involving spinal nerve compression with a range of symptoms including burning lower back pain that radiates down the legs -urinary urgency, frequency, and incontinence -muscle spasms in the back and legs -sensory deficits below the lesion site -and paraplegia or paraparesis.…”

The returned traveler with neurologic manifestations: could my patient have a parasite?

“…Subarachnoid neurocysticercosis (SANCC), a rare form of T. solium , consists of proliferating cestode membranes in the subarachnoid spaces, which slowly enlarge causing mass effect and inciting a host inflammatory response. The inflammation leads to arachnoiditis, hydrocephalus, infarcts, and focal neurological deficits and carries grave morbidity if not treated appropriately [59 ▪▪ ].…”

Older Age in Subarachnoid Neurocysticercosis Reflects a Long Prepatent Period

“…The insidious nature of its symptoms and the low sensitivity of conventional neuroimages 7 can make the diagnosis of subarachnoid disease challenging. Although it has been theorized that subarachnoid disease may have a prolonged incubation period, 8 it is still not clear how much it contributes to the age differences seen in clinical settings. Moreover, no animal models of subarachnoid NCC exist to clarify this point.…”