The many facets of disseminated parenchymal brain cysticercosis: A differential diagnosis with important therapeutic implications

Abstract

Neurocysticercosis (NCC), the infection of the nervous system by the cystic larvae of Taenia solium, is a highly pleomorphic disease because of differences in the number and anatomical location of lesions, the viability of parasites, and the severity of the host immune response. Most patients with parenchymal brain NCC present with few lesions and a relatively benign clinical course, but massive forms of parenchymal NCC can carry a poor prognosis if not well recognized and inappropriately managed. We present the main presentations of massive parenchymal NCC and their differential characteristics.

Human Neurocysticercosis: An Overview

“…Cysticidals should not be used in patients with parenchymal brain calcifications and are contraindicated in patients with cysticercotic encephalitis or in those presenting with the “starry-sky” appearance of parenchymal NCC. In these cases, their use may cause deleterious reactions due to the enhancement of the host inflammatory reaction against parasites [ 68 ].…”

Neurocysticercosis: A Review into Treatment Options, Indications, and Their Efficacy

“…19 Based on the evidence described, different sets of diagnostic criteria and proposals for particular settings have been produced. 12,[20][21][22]…”

“…No information comparing therapeutic schemes is available, but it is possible to avoid a generalized inflammatory response with several cycles of lower doses of anthelminthic instead of a single cycle with high doses. 12 The treatment of asymptomatic vesicular cysts is controversial because the evidence for specific management is lacking. The fact that calcified parasites are frequently diagnosed in asymptomatic patients without a history of seizures or other neurological symptoms shows that the process of parasite involution is frequently asymptomatic.…”

“…In this case, anthelminthic is contraindicated in the acute phase, where measures to decrease intracranial hypertension will be the only ones to be performed. 12 Calcified cysts required only symptomatic treatment, mainly AE. Duration of treatment is still not demonstrated, but it might be at least 2 years after the last seizure, although evidence is scarce.…”

“…Because the parenchymal location is the most common, epilepsy is the primary clinical manifestation of NC, occurring in 60–90% of patients. 12 , 13 When cysts are located in the extraparenchymal compartment, the main symptom is intracranial hypertension, it will occur in around 70% of patients. 11 In this location, stroke syndromes have been described in around 3% of the patients, mostly related to the initiation of treatment and its respective induced inflammatory response.…”