This document presents a case of neurocysticercosis in a 38-year-old male. On examination, he had decreased consciousness, unequal pupils, spastic muscles, and decreased strength. Investigations showed cysts in the brain and spleen. Neurocysticercosis is caused by the pork tapeworm Taenia solium and can infect the brain, eye, muscle or subcutaneous tissue. Symptoms depend on the location of cysts and include seizures, headaches, strokes and hydrocephalus. Diagnosis involves blood tests, imaging and biopsy. Treatment involves anti-parasitic drugs and corticosteroids.

1. NEUROCYSTICERCOSIS
Presented by
Dr. Faizunnessa
Medical Doctor
MSF KTP Clinic

2. OBJECTIVES
• Case presentation
• Introduction
• Pathogenesis
• Classification
• Clinical presentations
• Investigations
• Differential diagnosis
• Treatment

3. CASE PRESENTATION
• MD. Hossain Ahmed aged 38yrs a muslim unmarried nondiabetic
normotensive unmarried male heiled from KMS EXT has been
referred from BKL to our facilities as a case of somatoform
disorder & evaluated under mental health where he was
suspected as a case of Organic Psychosis. On evaluation of his
history we came to know that 10 days back he had only a history
of Diarrhoea & URTI for which he took some medication and
completely cured but recently for last 4 days he presented with
complaints of
• a) Giddiness followed by drowsiness
• b) Headache
• c) slurred speech followed by aphasia
• D) Abnormal movement of limbs

4. • Patient an young adult male aged 38 yr moderately built &
nourished.
• His vitals were stable,
• He is not anemic not jaundiced, no cyanosis, no clubbing ,no
generalized lymphadenopathy.
• System examination revealed no significant cardiovascular /
respiratory abnormal findings.
• Neurological Examination:
– HPF: Semiconcious; GCS:8-9/15.
– Pupils : Size R 4mm; L 3mm B/L brisk reaction to light &
accommodation Fundus Normal.
– No other significant cranial nerve palsies observed.
– Lead pipe rigidity present, Muscle tone spastic, R+J=E; &
Planter extensor B/L with MP 3/5.
CASE PRESENTATION----O/E

5. • Later on patients attendence with there own
interest done few investigations from outside and
got readmission in our facility & diagnosed as a
case of secondary mets of brain according to MRI
& received Dexamethasone + palliative Rx. But as
his USG showed Splenic cyst & MRI mets lesions
are quiet different from brain mets we suspected
it as a case of Neurocysticercosis & started our
Rx with a hope that some response may occur.
CASE PRESENTATION

10. INTRODUCTION
• NCC is the infection of the CNS by the larvae of Taenia solium.
• Neurocysticercosis (NCC) is the most common parasitic disease
of the nervous system.
• It is the leading cause of adult onset epilepsy (29% of epilepsy
in endemic regions world wide).
• It is endemic in Central and South America, sub-Saharan Africa,
and in some regions of the Far East, including most area of the
Asian subcontinent, Indonesia, and China, reaching an incidence
of 3.6% in some regions.
• Of note is the near absence of infection in Muslim countries,
where the consumption of pork is forbidden by Islam

11. Worldwide Prevalance

12. Pathogenesis
Cestodes/ Tapeworm
Human Definitive Host:
Taenia Saginata
Diphylobrothium
Hymenolepis
Dipyllidium Cannninum
Human Intermediate
Host:
Echinococcus
Either
Taenia solium

13. Mode of infection
• Hetero-inoculation
Eggs from the environment
• Internal auto-inoculation
Regurgitation of the proglottids into the
stomach
• External auto-inoculation
 From self??

14. Pathogenesis

16. Neuropathology
• Asymptomatic viable cysts
• Dying cysts
• Calcified cysts
• Racemose cysts
• Meningitis
• Vasculitis
• Hydrocephalus
• Intraventricular cysts
• Spinal disease
• Disseminated disease

17. Types of Cyst
• Cysticercus cellulosae:
 Less virulent.
 Small (<2cm, round, thin walled).
 In the parenchyma or Subarachnoid space.
 Often remain silent.
• Cysticercus racemose:
 The racemose (ie, appearing like a cluster of grapes) form refers
to the presence of multiple cysts without a scolex.
 May form giant vesicles up to 10 cm in diameter with predilection
for basal cisterns
 Cysticercotic arachnoiditis
 Presents as hydrocephalus / meningitis
 Can occlude vessels stroke
 Intense inflammation and seizures

18. Neurocysticercosis: Stages (Escobar)
• Vesicular:
 No Inflammatory Response
• Colloid-vesicular :
 Larva Begins to Degenerate, Scolex
Shrinks, Fluid Turbid, Surrounding
Edema: Enhancement
• Nodulo-granular:
 Capsule Thickens, Fluid Reabsorbed;
Scolex Mineralized
•
 Shrinks to Calcified Nodule

19. Neurocysticercosis
• While in the nervous system, the T solium parasite goes
through different stages of involution, which include the
following:

20. CLASSIFICATION
• Parenchymal NC
• Ventricular NC
• Basal Meningites
• Mixed forms

21. Extra Neural Cysticercosis
• Muscle and subcutaneous tissue:
Multiple subcutaneous nodules • Neck, Arm,
anterior chest wall, • Calf, Thigh.
• Ocular
 Extra ocular (muscle).
 Intra ocular

24. Clinical features
• Neurocysticercosis is a pleomorphic disease.
• Most symptomatic patients are 15–40 years old,
and the disease has no gender or race
predilection.
• Many are asymptomatic (80%).
• Peak is estimated to occur 3-5 years after
infection.
• The onset of symptoms is usually subacute to
chronic, with the exception of seizures, which
present in an acute fashion

25. • Cysticerci can be found anywhere in the body
but are most commonly detected in the brain,
cerebrospinal fluid (CSF), skeletal muscle,
subcutaneous tissue, or eye.
• Physical findings depend on where the cyst is
located in the nervous system.
• Symptoms are mainly due to mass effect,
inflammatory response, or obstruction of
foramina and ventricular system of brain.
Clinical features

26. Parenchymal NC
• Epilepsy
 It is the most common presentation (70%) of
neurocysticercosis
 It is the leading cause of adult-onset epilepsy.
SPS, GTC >> CPS
Risk of seizures in seropositive individuals 2-3 times
higher than seronegative controls.
• Headache, nausea, vomiting
• Strokes
 Lacunar infarcts and large cerebral infarcts due
to occlusion or vascular damage.
 Hemorrhage can also occur as a result of rupture
of mycotic aneurysms of the basilar artery.

27. • Frontal lobe involvement
 Psychosis, dementia, parkinsonism, intellectual
impairement
• Cerebellar ataxia
• Encephalitis and diffuse brain edema
 Common in children and young females
 Risk of developing severe neurological sequelae
Parenchymal NC

28. Intraventricular
- Constitutes 5-10%
- 4 th ventricle most common site of obstruction
- Lateral ventricular cysts less likely to cause obstruction
- Hydrocephalus without localizing signs
- Bruns’ syndrome : Unattached cysts may cause sudden
positional mechanical obstruction causing nausea, vomiting and
vertigo.
Meningeal cyst
- Meningeal Irritation signs
- Raised ICT from inflammation, edema

29. Presentations of other forms of neurocysticercosis
• Intracranial hypertension
• Neuropsychiatric disturbances
• Hydrocephalus(10-30%)
• Intrasellar neurocysticercosis
• Spinal neurocysticercosis --- rare 1% to3%

30. INVESTIGATIONS
• Peripheral eosinophilia only if cyst is leaking.
• Raised IgE level.
• Immunologic Testing
 ELISA (87% sensitive & 95% specific)
 EITB (95% sensitive & 100% specific)
• CSF Analysis:
 Mononuclear pleocytosis, usually not exceeding 200-300
cells/mm3
 Normal glucose levels,
 Elevated protein levels,(50-200 mg/dL)
 Eosinophilia
 High immunoglobulin G (IgG) index,
 Oligoclonal bands( in some).

31. • Stool Examination:
Taeniasis may be established by detecting T solium eggs
and proglottids in a patient's stool.
Taeniasis and neurocysticercosis coexist in 10-15% of
patients with neurocysticercosis.
Intestinal taeniasis is very common in patients with
massive infestation with cysticerci but without
cysticercotic encephalitis.
Tapeworm carriers may be identified by examining the
stool of the relatives of a patient with cysticercosis
encephalitis.
CT Scan +MRI/MRI SPET
INVESTIGATIONS

32. Differential Diagnosis
• Tuberculoma:
Usually Irregular,
 Greater Than 20 mm in Size.
 Often Associated with Severe Perifocal Edema and Focal
Neurological Deficit
• Secondary Mets of Brain with Occult Primary:
No evidence of Lung, Liver & bone mets clinically.
• Neuropsychiatric Manifestation of Wilson’s Disease:
Young patient with EPS, KF ring, Previous history of
jaundice, AST
• Ecchinococcosis:
• Somatoform disorder.

33. • Cryptococcosis:
presents as chronic or subacute meningitis. Associated
with papilloedema, hydrocephalus, focal deficits,
seizures and cryptococcomas. Cranial neuropathies,
especially of the lower cranial nerves, affecting one or
more cranial nerves
Immunocompromised
HIV-Sero+ve .
• Toxoplasmosis
Differential Diagnosis

34. Treatment
• Cysticidal therapy + steroids
• Corticosteroids alone
• Supportive
– Anticonvulsants
– Anti edema
– Analgesics
• Surgery

35. Thank you!