Intraventricular neurocysticercosis: 18 consecutive patients and review of the literature

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The prognosis for intraventricular neurocysticercosis (IVNCC) is poorer than that for parenchymal NCC, making prompt diagnosis and treatment especially important. Although active, viable intraventricular cysts produce no reaction in the host; they can cause noncommunicating hydrocephalus, the onset of which is frequently abrupt. With the death of the larva comes a local granulomatous ependymitis, generalized ventriculitis, and meningoencephalitis. The authors report on 18 patients with IVNCC (accrued from a larger case series of 62 patients with NCC treated over an 11-year period), detailing clinical presentation, neuroimaging findings, treatment, and outcome.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>All patients presented with hydrocephalus and/or meningitis. The most valuable diagnostic tests were magnetic resonance imaging of the brain and EITB of serum and/or cerebrospinal fluid. Treatment included albenda-zole and steroid therapy in all cases, and when necessary in cases requiring urgent or emergency ventriculostomy and/or surgical removal of the obstructing cyst (followed by shunt placement if indicated).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>An extensive review of the literature on IVNCC has been prepared, with the goal of providing the reader with the information necessary to diagnose and treat this complex and potentially fatal disease in a timely and effective manner.</jats:p></jats:sec>

An Unusual Presentation of Neurocysticercosis: A Space-Occupying Lesion in the Fourth Ventricle Associated with Progressive Cognitive Decline

“…[10][11][12] The role of anthelmintic therapy in intraventricular NCC remains uncertain: intraventricular NCC may respond favorably to albendazole, but both failures and successes with praziquantel have been reported. 13 Apart from that, albendazole is preferred over praziquantel because of its better penetration into the CNS, greater cysticidal effect, and less interaction with other drugs such as steroids. 9,10 Further beneficial effects of anthelmintic drugs are the destruction of additional cysts, if present.…”

“…[2][3][4][5] Especially, fourth ventricular cysts should undergo extirpation, because this form may cause brainstem compression even after insertion of a VP shunt. 13 Furthermore, a VP shunt is usually required in patients with chronic hydrocephalus and chronic increased intracranial pressure. 13 In a recently published meta-analysis about the treatment of intraventricular NCC, the authors proposed medical treatment in cases of intraventricular NCC without hydrocephalus or in cases with surgically non-accessible cysts and surgical treatment in cases with hydrocephalus.…”

“…13 Furthermore, a VP shunt is usually required in patients with chronic hydrocephalus and chronic increased intracranial pressure. 13 In a recently published meta-analysis about the treatment of intraventricular NCC, the authors proposed medical treatment in cases of intraventricular NCC without hydrocephalus or in cases with surgically non-accessible cysts and surgical treatment in cases with hydrocephalus. They suggested postsurgical medical therapy (anthelminthic medication and steroids) in cases with incomplete resection or spilling and/or the presence of further cysts.…”

“…9,10 Further beneficial effects of anthelmintic drugs are the destruction of additional cysts, if present. 13,14 Corticosteroids are used to relieve inflammatory symptoms/signs caused by larval death (headache, nausea, vomiting and seizures), that usually occur 2-5 days after initiation of anthelminthic therapy. 10,13 Surgical removal of cysts is required in complicated cases with acute obstructive hydrocephalus.…”

“…13,14 Corticosteroids are used to relieve inflammatory symptoms/signs caused by larval death (headache, nausea, vomiting and seizures), that usually occur 2-5 days after initiation of anthelminthic therapy. 10,13 Surgical removal of cysts is required in complicated cases with acute obstructive hydrocephalus. [2][3][4][5] Especially, fourth ventricular cysts should undergo extirpation, because this form may cause brainstem compression even after insertion of a VP shunt.…”