Neurocysticercosis: mimics and chameleons

Abstract

Neurocysticercosis is the most common parasitic neurological disease worldwide, yet in Europe, it remains relatively uncommon, with many practitioners rarely seeing a case. However, immigration and international travel mean that it is becoming increasingly recognised and diagnosed in developed countries. Being a treatable condition, it is essential to be familiar with the diagnosis and to appreciate its mimics and breadth of its possible clinical presentations.

Atypical radiological presentation of multiple cystic brain metastases from lung cancer simulating neurocysticercosis

“…There are four recognised stages: vesicular, colloidal vesicular, granular nodular and nodular calcified 12. The vesicular pattern is characterised by a cyst with a thin wall, no perilesional oedema or contrast enhancement and an intralesional eccentric bright dot representing the scolex, appearing hypointense within hyperintense cystic lesions in T2 sequences (hole-in-dot sign) 11 13. The ring enhancement with perilesional oedema is typical of the colloidal vesicular stage NCC, whereas calcifications are a hallmark of the final evolutionary stage of the cysticercus, but sometimes they raise suspicion of tuberculosis 11 13.…”

“…The vesicular pattern is characterised by a cyst with a thin wall, no perilesional oedema or contrast enhancement and an intralesional eccentric bright dot representing the scolex, appearing hypointense within hyperintense cystic lesions in T2 sequences (hole-in-dot sign) 11 13. The ring enhancement with perilesional oedema is typical of the colloidal vesicular stage NCC, whereas calcifications are a hallmark of the final evolutionary stage of the cysticercus, but sometimes they raise suspicion of tuberculosis 11 13. Cysts can occur in the brain parenchyma (parenchymal NCC) or CSF compartments (extraparenchymal NCC), and occasionally, patients have both localisations 11 13.…”

“…The ring enhancement with perilesional oedema is typical of the colloidal vesicular stage NCC, whereas calcifications are a hallmark of the final evolutionary stage of the cysticercus, but sometimes they raise suspicion of tuberculosis 11 13. Cysts can occur in the brain parenchyma (parenchymal NCC) or CSF compartments (extraparenchymal NCC), and occasionally, patients have both localisations 11 13. Furthermore, many lesions in different stages and locations can be frequently detected and are considered a typical feature of NCC.…”

“…The thorough investigation, conducted by a brain MRI, showed multiple supratentorial and infratentorial cystic lesions localised at the grey and white matter junction, thalamus, basal ganglia and brainstem, characterised by mild perifocal oedema and ring enhancement (figure 2). Furthermore, there was hypointense signal within many cystic lesions as often reported in NCC (‘hole-in-dot’ sign) 11. Diagnostic workup for HIV, borreliosis, echinococcosis, toxoplasmosis and tuberculosis was negative.…”

Hydrocephaly and secondary intracranial hypertension to racemosa neurocysticercosis

“…In the intraparenchymal form, seizures are almost pathognomonic for this condition. 8,10 And in general, in up to 70% of patients, they represent the first manifestation of the disease and occur, mostly, due to the degeneration of the parasite or the release of antigens from the calcified cysticercus. 11 Thus, it is justifiable that the main stages of cysticerci found by neuroimaging are the final stages, the granular stage, and the calcified stage.…”