Neurocysticercosis and its management in pediatric age group.difference between neurocysticrcosis and tubercuolma based on imaging.Life cycle of Neurocysticercosis.

1. NEUROCYSTICERCOSIS
Dr. Prashant Raj Bhatt
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2. Contents
 Introduction to Taeniasis
 Lifecycle of Taenia solium
 Anatomical Classification of NCC
 Stages of cyst formation
 Diagnosis
 NCC vs Tuberculoma based on imaging
 Management of parenchymal NCC
 Prevention and control
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3. Neurocysticercosis
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Definitive host:
Human
Intermediate host:
Cow/Cattle
• Definitive
host: Human
• Intermediate
host: Pig

4. Taeniasis
 Taeniasis is the infection of humans with the adult tapeworm
of Taenia saginata, T. solium or T. asiatica
 Taenia solium (pork tapeworm) is the main cause of human
cysticercosis
 Cysticercosis
 Caused by the presence, of the larval forms of
 Taenina solium i.e Cysticercus cellulosae and Cysticercus racemose
 T. saginata i.e Cysticercus bovis occurs very rarely
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6. Target Tissues
Eyes
CNS
Striated muscles
Probably due to high glycogen and glucose content of these
tissues
CNS and Eye involvement is termed as Neurocysticercosis

7. Clinical features
Diverse clinical presentation of NCC is determined by:
Location of cysts
Size of cysts
Cyst load (number of cysts)
Host’s immune response

8. Anatomical Classification of NCC
 Parenchymal
 Intraventricular
 Meningeal
 Spinal
 Ocular Nelson

9. Parenchymal NCC
 Seizures (87%)
Simple partial with secondary generalization
 Generalized tonic-clonic
 Complex partial or complex partial with secondary generalization
 Headache, nausea and vomiting
Stroke
Hemiparesis
Focal neurologic deficits
Frontal lobe involvement
Psychosis, dementia, intellectual impairment

10. Intraventricular NCC
 5- 10% of all cases
 4th ventricle :Most common site for obstruction
 Up to 20% of cases is associated with obstructive
hydrocephalus and signs of raised ICP

11. Meningeal NCC
Meningeal irritation resembling Tubercular meningitis
 Raised ICP from inflammation, oedema and presence of
cyst obstructing flow of CSF

12.  Spinal NCC
– Spinal cord compression
– Nerve root pain
– Transverse myelitis
Ocular NCC
– Visual impairment (decreased visual acquity)
– Retinal detachment, iridocyclitis
iridocyclitis - inflammation of the iris and ciliary body of the eye

13. 1. Vesicular stage
 Viable parasite with intact membrane and therefore no host
reaction
2. Colloidal vesicular stage
Parasite dies and the cyst fluid becomes turbid
 As the membrane becomes leaky oedema surrounds the cyst
Most symptomatic stage
Stages of Cyst Formation

14. 3. Granular nodular stage
 Oedema decreases as the cyst retracts
4. Calcified nodular stage
End-stage quiescent calcified cyst remnant
No oedema
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15. 16
Collloid vesicular stage
Ring enhancing lesion
(cyst with dot sign)
Calcified Nodular Stage
Vesicular Stage

16. Diagnosis
 Fundoscopy
 CT with contrast
 MRI: Cyst location, viability, and associated inflammation
 Serology
Enzyme-linked immunotransfer blot (EITB): serologic diagnosis
sensitivity of 98% specificity of 100%
ELISA in CSF
sensitivity of 87% specificity of 95%
 Biopsy and histopathology

17. Differential Diagnosis
Based on imaging differential diagnosis include:
Tuberculoma
Cerebral metastasis(es)
Pyogenic cerebral abscess
Amoebic encephalitis
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18. Cysticercus Granuloma Tuberculoma
Round in shape Irregular in shape
Cystic Solid
20 mm or less with ring
enhancement or visible scolex
Greater than 20mm
Cerebral edema not enough to
produce midline shift
Severe perifocal edema, midline
shift and raised ICP
Usually focal neurological deficit is
not present
Focal neurological deficit
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19. Contd..
CECT of Brain showing degenearting cyst
with eccentric scolex with perilesion edema
in rt frontal lobe
Caseating granulomatous inflammation
associated with a fibrous type capsule,
20OP ghai, pediatrics

20. Management
 Symptomatic treatment for seizure
Antiparasitic Therapy
Steroid
Surgical Intervention:
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21. Anticonvulsant Therapy
Management of seizure due to NCC
Phenytoin or carbamazepine or sodium valporate
Upto 6 to 12 months after radiographic resolution of active
parasitic infection
If seizures are recurrent or associated with calcified lesions:
should be continued for 2-3 yr before attempting weaning from
anticonvulsants
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22. Prior to Therapy
These condition should be ruled out prior to initiating
anti parasitic and steroid therapy
Tuberculosis
Ocular cysticercosis
Strongyloidiasis
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23. Anti-Parasitic Therapy
Albendazole:
Most commonly used antiparasitic (15 mg/kg/day PO in two daily
divided dose)
 Can be taken with a fatty meal to improve absorption
Most common duration of therapy is 7 days for parenchymal
lesions
For multiple lesions or subarachnoid disease
 longer duration(8-15 days), higher doses (up
to 30 mg/kg/day), or combination therapy with praziquantel
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24. Praziquantel:
 50-100 mg/kg/day PO divided tid for 28 days can be
used with albendazole or as an alternative to it
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25. Steroids
Prednisone 1-2 mg/kg per day or oral dexamethasone 0.15
mg/kg per day
Should be started before the first dose of antiparasitic
drugs and continuing for at least 2 wk
Methotrexate :
used as a steroid-sparing agent in patients requiring
prolonged antiinflammatory therapy
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26. Indication of Surgery
 Symptomatic hydrocephalus due to NCC
 NCC of ventricle
 Giant cysticerci with life-threatening mass effect
 cysticerci adjacent to vascular structures
 Ocular and spinal NCC
Giant cysticerci : Rare condition defined as size in its largest dimension 27

27. Follow up and monitoring
 Intermittent radiographic surveillance to evaluate for resolution of
the cysticerci and development of calcifications
 Imaging at 1 to 2 month and 6 month
 Imaging should be repeated prior to discontinuing antiepileptic
drugs
 Antiparasitic therapy should be considered for patients with growing
cysts off therapy 28

28. Prevention and Controll
 Wash hands with soap and warm water after using the toilet,
changing diapers, and before handling food
 Wash and peel all raw vegetables and fruits before eating
 Adequate cooking of meat products
 Storage of meet in freezing condition*
 Veterinary vaccines for several cestode infections
Note *: (Cysticerci do not survive temperatures below -10o C and above 50o C)

29. THANK YOU
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