A 16-year-old boy was admitted with abnormal movements of his left thumb and left eyelid for over 1 hour. MRI scans showed lesions in his brain consistent with neurocysticercosis. Neurocysticercosis is caused by the pork tapeworm Taenia solium and has four pathogenic stages seen on imaging. The patient's symptoms, travel history, imaging findings, and positive blood tests confirmed a diagnosis of neurocysticercosis. He was treated with anti-seizure medications, anti-parasitic drugs, and steroids to reduce inflammation from degenerating parasites.

1. IMAGE OF THE WEEK
Prof.Dr.P.Vijayaraghavan’s Unit
Presented by
Dr.T. Jaya Packiam

2. CASE SUMMARY
A 16 years old boy admitted with complaints of Abnormal
movement left thumb and left eyelid more than 1 hour.
Patient takes mixed diet
General examination and systemic examination were
unremarkable.
Routine investigations CBC LFT RFT ECG CXR were also
normal.

3. T1 WEIGHTED MRI

4. T2 WEIGHTED MRI

5. MRI FLAIR

6. MRI CONTRAST

7. DIFFERENTIAL DIAGNOSIS
Infections- neurocysticercosis, tuberculomas ,
toxoplasmosis, cryptococcosis
histoplasmosis,candida albicans
Metastases
Abscesses
Granulomas
 Resolving hematomas
Primary cns lymphomas
Multiple sclerosis
Vascular malformations
Thrombosed aneurysms

8. Tuberculomas NEUROCYSTICERCOSIS
1.Usually larger>2CM and usually multiple Smaller<2CM,may be single or multiple
2.Associated with basal meningitis or
hydrocephalus.
NOT ASSOCIATED.
3.They are more common in posterior
fossa .
Most commonly occur at the gray-white
junction.
4.Look for CF of tb elsewhere lungs,lymph
nodes,intestine.
Look for occular involvement,muscle
involvement or subcutaneous nodules
5.T2 weighted MRI shows
Hypointense.
scolex will be absent.
Midline shift will be present.
Conglomerate enhancement
T2 weighted MRI shows
Hyperintense.
scolex will be present.
No Midline shift.
Isolated ring enhancement.
6.MR spectroscopy may show lipid peaks
with tuberculoma.
MR spectroscope may show multiple
amino acid peaks.

9. MRI FINDINGS IN
NEUROCYSTICERCOSIS
T1W1 T2W2 MRI FLAIR
VESICULAR-ISOINTENSE TO
CSF,DISCRETE ECCENTRIC
SCOLEX(HYPERINTENSE)
ISOINTENSE TO
CSF.DISCRETE
ECCENTRIC SCOLEX.
NO EDEMA.
ISO INTENSE TO CSF.
DISCRETE
ECCENTRIC SCOLEX
NO EDEMA
COLLOIDAL VESICULAR-CYST
MILDLY HYPERINTENSE TO
CSF
HYPERINTENSE TO
CSF,MILD TO MARKED
EDEMA
HYPERINTENSE TO
CSF,MILD TO MARKED
EDEMA
GRANULAR NODULAR-
THICKENED RETRACTED CYST
WALL.EDEMA DECREASES.
NODULAR CALCIFIED-
DIFFICULT TO DETECT
THICKENED
RETRACTED CYST
WALL .EDEMA
REDUCED.
SHRUNKEN
CALCIFIED LESION

10. DISCUSSION
• Neurocysticercosis is the most common parasitic disease
of CNS.
• Intraparenchymal parasitic infection caused by pork
Tapeworm Tinea solium.
• 4 pathogenic stages
• -Vesicular(larva alive)
• -colloidal vesicular(degenerating larva)
• -granular nodular(healing)
• -nodular calcified.(healed)

12. Cut section of brain affected by NCC

13. GENERAL FEATURES
Location: cysterns>parenchymal>ventricles
-parenchymal cyst often hemispheric at grey white
junction.
-Intraventricles often isolated
-Basal cisterns cysts may be racemose(Multiple Grapelike)
-Size of the cyst 1-2cm and scolex will be 1-4mm.
-Lesions may be different stages in same patient.

14. CINICAL FINDINGS
New onset seizures with or without generalisation
May involve brain parenchyma – seizure/FND
Subarachnoid space / Ventricular Space – May mimic
Intraspinal tumors.

15. Cysticercosis can be diagnosed several
ways.
• Travels
• Eating
• MRI or CT brain scans
• Blood tests-ELISA

16. TREATMENT
• ANTI CONVULSANT THERAPY:
CAN BE STOPPED ONCE CT SHOWS RESOLUTION
OF LESION
• ANTIHELMINTHIC THERAPY:
• ALBENDAZOLE 15MG/KG/DAY IN 2DOSES FOR 8DAYS
• PRAZIQUANTEL 50MG/KG/DAY TDS FOR 15 DAYS
TO REDUCE THE INFLAMMATORY RESPONSE OF
DEGENERATING PARASITES.
• PREDNISOLONE/DEXAMETHASONE.

17. THANK YOU
Thank you..........