Neurocysticercosis is a parasitic infection caused by ingesting eggs from the Taenia solium tapeworm, which can lead to cyst formation in the brain and central nervous system. Symptoms include seizures, headaches, and vision changes. It is diagnosed through imaging tests, stool and blood tests, and biopsy. Treatment involves antiparasitic medications like albendazole and praziquantel to reduce cysts and seizures, along with corticosteroids to reduce inflammation. Outcomes depend on the location, size, and number of cysts present and the body's immune response.

1. NEUROCYSTECERCOSIS
• DR SANDEEP BHARAT GADADE
• COMMAND HOSPITAL LUCKNOW.

2. NEUROCYSTECERCOSIS
• Cysticercosis - Parasitic infection that results from ingestion of eggs from
the adult tapeworm, Taenia solium .
• Cysticercosis involves the central nervous system, it is called
neurocystcerocosis.
• Neurocystcerocosis is acquired through consumption of food contaminated
with feces of a T. solium tapeworm carrier (i.e., through fecal–oral contract).

3. MODE OF INFECTION
• Humans are both intermediate and definitive host.
• Cysticercosis developed when humans are intermediate host by ingesting
embryonated egg of tape worm.
• Release oospore penetrate gut and disseminate in body tissue.
• Heteroinoculolation - Egg from environment.
• Internal inoculation – Regurgitation from progotids into stomach.
• External inoculation – from infection person.

4. TARGET TISSUE
• Predilection to eye, CNS, striated muscle due to high glycogen and glucose.
• CNS And Eye involvement is termed as neurocystcerocosis.
• C/f – Manifestation and clinical features depends on
• location of cyst.
• Size of cyst,
• number of cyst
• Host immune response.

5. C/F
• SEIZURE – 70-90 % patient present with the seizure
Partial onset with or without secondary generalization.
• Headache- indicates increased ICP or meningitis, or hydrocephalus.
• Nausea, vomiting
• Ocular Cysticercosis may present with decreased VA

6. PATHOGENESIS.
• Eggs of the tapeworm are shed in stool and contaminate food through poor
hygiene.
• When these eggs are ingested and exposed to gastric acid in the human stomach,
• lose their protective capsule and turn into larval cysts, called oncospheres.
• Oncospheres cross the gastrointestinal tract and migrate via the vascular system to
the brain, muscle, eyes, and other structures.
• Once in the brain, the larval cysts (cysticerci) initially generate a minimal immune
response and may remain in the brain as viable cysts for years.

7. Life cycle of TINEA

8. stages of cysts within the parenchyma of the brain
• Vesicular : Magnetic resonance imaging (MRI) of a vesicular cyst. Note the well-
defined scolex, minimal contrast enhancement, and mass effect.
• Colloidal -MRI of a colloidal cyst. Note ring enhancement, loss of the scolex, and
perilesional edema.
• Nodular/granular stage - Note nodule with diffuse enhancement and no cystic
component.
• Calcified granuloma- Noncontrast computed tomography showing multiple
punctuate calcifications.

9. INVESTIGATION
• Stool routine And microscopy.
• Fundoscopy
• Biopsy & Histopathology.
• CT with contrast,
• MRI
• ELISA CSF - Detection of anticysticercal antibodies in the CSF by ELISA is 89%
sensitive and 93% specific in patients with viable neurocystcerocosis infections.
• Enzyme-linked immunoelectrotransfer blot (EITB) assay - Uses lentil lectin purified
glycoprotein antigens (LLGP) to detect antibodies to T solium in serum. EITB sensitivity
is around 98% for patients with two or more live parasites in the nervous system.

11. Treatment
Treatment may changes with location of involvement
Intraparenchymal – calcified lesion or viable degenerative lesion.
Extraparenchymal- intraventricular involvement or subarachnoid.

13. • Albendazole and praziquantel are the principal ant parasitic drugs used to treat
neurocystcerocosis.
• Antiparasitic drugs praziquantel and albendazole reduce the number of cysts and
frequency of seizures.
• Albendazole 15mg/kg/day – fatty meal improves absorption
• 7 days for single parenchymal lesions.
• Longer duration and higher doses ( upto 30mg/kg/day) or combination with
praziquantel for multiple lesions or subarachnoid involvement.

14. +
• Recent trials Showed improved resolution with combination therapy of
Albendazole, praziquantel and corticosteroids.
• Praziquantel 50-100mg/kg/day Divided doses daily for 28 days can be used
in combination with Albendazole or alternative to it.
• Patient should be medicated with prednisolone 1-2mg/kg/day or oral
dexamethasone 0.15mg/kg/day before starting antiparsititc drug .
• Methotrexexate can be used alternative to steroids as steroids sparing agent
in prolong anti-inflammatory therapy.

15. • THANK YOU