Subarachnoid racemose neurocysticercosis with cerebellar involvement: an old friend in an infrequent location?

Abstract

Taenia solium is the most common parasitic infection of the central nervous system and it can cause parenchymal or extra-parenchymal lesions. Subarachnoid cysticercosis is a type of extra-parenchymal infection in which the prevalence is not known and racemose NC with cerebellar involvement has been rarely reported. The diagnosis is challenging because of its similarity to other infectious diseases or to subarachnoid involvement of systemic malignancies. Treatment usually requires cysticide drugs, however, there are no randomized studies concerning the anti-parasitic treatment in subarachnoid NC. We present a case of racemose NC in the cerebellar hemisphere to draw attention to this pathology, endemic in many parts of the world; and highlight all the current gaps in our understanding of this entity.

Ultrasound-guided resection of cerebellar racemose neurocysticercosis: novel insights from a unique scenario

“…RNC lesions typically have a cystic appearance without a scolex in the parenchyma, ventricles, or extra ventricular tissue [ 1 , 3 ]. Invasion of the subarachnoid space or parenchymal tissue is less frequent but has a greater risk of cystic growth, given the expansible nature of these compartments [ 3 ].…”

“…RNC lesions typically have a cystic appearance without a scolex in the parenchyma, ventricles, or extra ventricular tissue [ 1 , 3 ]. Invasion of the subarachnoid space or parenchymal tissue is less frequent but has a greater risk of cystic growth, given the expansible nature of these compartments [ 3 ]. As a result, patients can develop clinical symptoms and signs secondary to space-occupying lesions, such as obstructive hydrocephalus, meningitis, and potentially herniation, with a mortality rate of up to 50% [ 2 , 4 ].…”

Silent Intruder: Unusual Presentation of Neurocysticercosis in an HIV-Infected Patient from the Far Northern Brazilian Amazon

“…In extraparenchymal infection, cysticerci can cause intracranial hypertension with hemiparesis, hydrocephalus, partial seizures, and focal neurological signs due to obstruction of cerebrospinal fluid flow or a strong inflammatory reaction, and if not properly treated, it can lead to death and disability [ 20 ]. The prevalence of extraparenchymal NCC is still not well understood, but it is a condition with a poor prognosis, and the mortality rate ranges from 20% to 50% of affected patients [ 21 ].…”