Imaging in neurocysticercosis

Abstract

Neurocysticercosis is a parasitic neurological infection caused by the ingestion of larvae from the adult tapeworm Taenia solium. We describe a man who presented with generalised tonic-clonic seizures. He had been previously diagnosed with epilepsy in Malawi, where he had emigrated from 2 years before this episode. An MRI was performed to further investigate the cause of his seizures, as no previous imaging had been performed. His initial MRI showed multiple characteristic cystic lesions in keeping with neurocysticercosis.

Neurocysticercosis: mimics and chameleons

“…Neurocysticercosis is caused by the larvae of the pork tapeworm ( Taenia solium ) in the nervous system and is acquired from a human carrier through faecal–oral route 1–3. It is the most common parasitic neurological disease worldwide and is still endemic in low-income countries that have poor sanitation, especially Latin America, sub-Saharan Africa and Southeast Asia.…”

“…Almost all UK-reported cases are imported (table 1). 3–5 Its treatment is complex, must be individualised, and has been reviewed elsewhere 1 6. Its prognosis has improved in recent decades, mainly due to better neuroimaging and the use of antihelmintics (albendazole and praziquantel) 1…”

Neurocysticercosis in a young Indian male

“…1,2 Characteristic radiological features include dystrophic calcification on CT imaging, cyst wall contrast enhancement on T1-weighted MRI and identification of the pathognomonic scolex, an eccentric focus of enhancement representing the tapeworm's head, best delineated with fluidattenuated inversion recovery sequences (holewith-dot sign). 3,4 Brain abscess or metastases are important differential diagnoses as they are also similarly located at the grey-white matter junction of the middle cerebral artery distribution, associated with disproportionately significant perilesional cerebral oedema and classically exhibit heterogeneous contrast enhancement. Malignant glioma was less likely in our patient since they are morphologically more infiltrative, and the present lesion was well-circumscribed.…”

“…3 In endemic areas, the most common presentation is epilepsy, responsible for 30% of cases. 1 Focal neurological deficits may occur including cranial nerve palsy due to basal meningitis.…”

“…2,3 Within 72 hours of ingestion, larvae known as oncospheres are released and pass through the intestinal wall into the circulation, subsequently depositing in the CNS, retina, and skeletal muscle as cysticerci.…”