Neuro ocular cysticercosis


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taenia solium in brain & eye.. diagnosis is clinico- radiological

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Neuro ocular cysticercosis

  1. 1. By: Dr Rekha Khare MD.Radiology
  2. 2. Cysticercosis  It is an infection by a parasite Taenia solium, a pork tapeworm forms cysts in different parts of body
  3. 3. Neurocysticercosis  It is parasitic infestation affecting CNS in about 90% patients with cysticercosis a common neurological disease in developing countries
  4. 4. Taenia solium Two host zoonotic cestode Adult stage lies in small intestine of human Gravid proglottid at terminal end of worm full of eggs that are source of infection with larval stage/ cysticercosis
  5. 5. Taenia solium contd….. Intermediate host is pig harvouring larval cyst anywhere in it’s body Human gets infected with cyst by accidental ingestion of T. solium eggs by fecal- oral contamination
  6. 6. Clinical presentation Depends on: site of lesion number of lesion host immune response
  7. 7. Sites for Neurocysticercosis Meningeal_ basal meninges Parenchymal cerebral cortex rarely white matter Ventricular_ 50%cases in 4th Spinal cord rare_ blood or ventriculo-ependymal spread
  8. 8. Neuro-symptoms/signs Fits/ seizures/ epilepsy-70% Stroke/ TODD paralysis Headache/ Hydrocephalus Neuropsychiatric dysfunction
  9. 9. Ocular cysticercosis In 5% cases of cysticercosis Cyst may float freely in anterior/ vitreous chamber Cyst may adhere to retinal & sub retinal tissue Rarely in eyelid & lacrimal gland
  10. 10. Ocular- symptoms/signs Chorioretinitis Vitreous detachment Diminution/ loss of vision patient complaints of painful, swollen eye with gradual loss of vision
  11. 11. CT findings….. Depends on stage of evolution of infestation 1.Vesicular stage -viable Hypo dense nonenhancing lesion 2. Colloid stage- degeneration Hypo/ isodense lesion with peri. lesional enhancement/ oedma
  12. 12. CT finding contd….. 3.Nodular Granular stage nodular enhancing lesion 4.Active parenchymal stage scolex within a cyst may appear as a hyper dense dot
  13. 13. CT finding contd….. 5.Calcified stage- parasite dies nodular parenchymal calcification 6.Cysticercotic encephalitis diffuse oedma, collapsed ventricle multiple enhancing parenchymal lesion
  14. 14. Case no. 1 A lady 30yr was sent in the department of Radiology for CT scan of head
  15. 15. Case 1 contd. History Severe headache for months Often Fits Patient was treated in village by some quacks. NO RESPONSE
  16. 16. Case 1……CECT Head
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  22. 22. CT scan finding Most of the brain parenchyma is riddled with numerous cysts of varying size(1-10mm), with dot calcificaion, few nodular calcification & tiny hypodense nonenhancing lesion
  23. 23. Diagnosis case no.1 NEURO-CYSTICERCOSIS brain parenchyma is riddled with cysts…..characteristic images with all stages of evolution of parasite
  24. 24. Case no.2 A lady aged 40yr came in the department of Radiology for CT scan head
  25. 25. Case no.2 contd.History Patient complained of-  Painful swollen eye  Headache  Gradual loss of vision
  26. 26. Clinical examination On slit lamp exam two VIABLE MOBILE larva are visualized in anterior chamber of left eye
  27. 27. Plain CT scan brain……
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  31. 31. Ocular region…..
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  33. 33. CT scan finding Few calcifications in posterior ocular wall close to optic nerve head both eye Few dot calcification with minimal perilesional oedma
  34. 34. Diagnosis case no. 2 NEURO-OCULAR CYSTICERCOSIS In correlation with slit lamp exam. anterior chamber VIABLE PARASITE SEEN
  35. 35. Diagnosis depends on…  Clinical history  Lab test (enzyme linked immunotransfer blotting)  Imaging finding No diagnostic tests identify all cases of cysticercosis
  36. 36. Neuroimaging Since the introduction of CT & later MRI, vast majority of single enhancing lesion until then attributed to Tuberculosis were in fact degenerating CYSTICERCI