Giant Neurocysticercosis Cyst in the Cerebellar Hemisphere-Case Report-

Abstract

A 67-year-old man presented with dizziness, nausea, and ataxia. Magnetic resonance imaging showed a large (5.5 × 4 × 4 cm) cystic lesion in the left cerebellar hemisphere with internal septation, a mural nodule, and thin rim enhancement. Cystic cerebellar tumor such as hemangioblastoma was initially suspected. Following surgery, the cyst was identified as cerebellar neurocysticercosis. Neurocysticercosis is the most common parasitic disease of the central nervous system but is occasionally misdiagnosed as tumor because of the varying neuroimaging presentation. This case shows that neurocysticercosis should be considered in the differential diagnosis of giant cystic lesions in the cerebellum as surgical intervention may be unnecessary.

Extraparenchymal (Racemose) Neurocysticercosis and Its Multitude Manifestations: A Comprehensive Review

“… 7 Cysticercosis in a cerebellar location is rare, but there have been a few case reports. 8 9 The rarity of cysticercosis in the cerebellum may be attributable to its less-abundant blood flow relative to the cerebrum.…”

Neurocysticercosis presenting as a locked-in lateral ventricle: A case report and evidence-based review

“…The most frequent brain parenchymal location is in the cerebral hemispheres, typically at the gray-white matter junctions. Cerebellar involvement, on the other hand, is rare, with only a few reports available [17] , [18] , the issue that might be due to the poor cerebellar vascular circulation compared to cerebral circulation.

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Uncommon Clinical Manifestations of Cysticercosis

“…[72] In patients presenting huge cystic lesions due to PFNCC then intermittent severe headache, epilepsy, and signs of raised intracranial pressure, cerebellar signs and cranial nerves signs can be seen. [63,73] Studies post-mortem have confirmed this correlation between signs of increased intracranial pressure, localizing cerebellar signs and even hearing loss in patients presenting PFNCC in the cerebellopontine cistern and obstructive hydrocephalus. [74,75] Sang-Wook et al [76] reported a case presenting headache, dizziness, drowsiness and ataxic gait.…”

“…As has been mentioned, T solium cysticercosis spread through the bloodstream and it may locate almost anywhere in the CNS, most frequently involves the cerebral hemispheres and sometimes ventricles, basal cisterns, subarachnoid space, and spinal cord. Cerebellar cysticercosis has been rarely reported [77][78]. Anecdotal presentations include multiple cranial nerve involvement (V, VI, VII, VIII) and cerebellar signs resembling anterior inferior cerebellar artery (AICA) syndrome.…”