Neurocysticerosis

Worm in the Eye: A Case Report of Ocular Neurocysticercosis With Adherent Retinal Cyst

Neurocysticercosis is caused by cysticercus cellulosae, the larval stage of Taenia solium, commonly referred to as the pork tapeworm. These larvae form cysts in several organs, including the brain, spinal cord, and eye. Neurocysticercosis is recognized by the World Health Organization as a public health issue and stands as the foremost preventable cause of epilepsy worldwide. Ocular neurocysticercosis refers to the concurrent involvement of the eyes and brain with cysticercus lesions. Neurological symptoms include focal deficits, intracranial hypertension, or cognitive decline. In the eye, the orbital type commonly presents with periocular swelling, ptosis, diplopia, restriction of ocular motility, or decreased vision. The ocular type shows signs of retinal detachment, a macular hole, and inflammation. A 45-year-old female presented with pain in his right eye with blurred vision for 15 days. On USG and MRI of the eye, a thin-walled lesion was noted. The brain showed a few calcified granulomas in the right parietal lobe on MRI. The left eye was normal. If left untreated, the cysts can lead to a severe inflammatory reaction in the eye, which may eventually lead to blindness. This blindness caused by cysticercus is preventable, and hence, early diagnosis and prompt medical or surgical treatment are essential.

Vertigo: An Atypical Presentation of Neurocysticercosis Successfully Treated With Albendazole

A 20-year-old male presented to our facility with a worsening sensation of "the room spinning around" himself for the past three weeks. In the last week, he began to experience daily spells lasting for three hours each without losing consciousness. The patient had recently migrated from Central America six weeks prior to admission. On physical examination, his vital signs were within normal limits, with no focal neurological deficits. Magnetic resonance imaging (MRI) of the brain revealed a cystic-appearing lesion in the fourth ventricle with associated mass effect on the posterior aspect of the brainstem and mild periventricular edema. Laboratory studies were unremarkable except for a positive anti-cysticercus IgG antibody, which confirmed the diagnosis of neurocysticercosis. Initially, surgery was considered, but the neurosurgeons advised medical management due to the small size of the lesion. The patient was started on albendazole 400 mg orally twice daily and dexamethasone 6 mg orally daily for 14 days. The patient responded well; his symptoms resolved by the eighth day. He was discharged home to complete his treatment and remained asymptomatic at the follow-up appointment two weeks later.

Taenia solium taeniasis and Cysticercosis Prevalence and Control Practice in China

Taenia solium taeniasis/cysticercosis is an important global food-borne zoonosis transmitted between humans and pigs. In China, the prevalence of Theridion solium taeniasis/cysticercosis has been marked decline in recent decades based on the data revealed by both national surveys and field prevalence investigations. Health education and promotion, meat inspection, and chemotherapy are unquestionably the main control measures for diseases. It is worth noting that a variety of socio-ecological variables have been identified in the process of controlling T. solium taeniasis/cysticercosis. It has become difficult for pigs to come into direct or indirect contact with or consume human excreta as pig farming practices have been shifted from traditional backyard farms to large-scale commercial pig raising systems that are still in progress. The human toilet revolution in rural areas of China has ensured hygienic separation of human excreta from contact, and thereby preventing human excreta from polluting the soil, feeds, and water. These two important fundamental preventive measures are crucial to establishing an environmental restriction between humans and pigs cannot be overlooked for interrupting or limiting T. solium transmission. In this chapter, we reviewed the epidemiology, traditional measures, and ecological determinants that significantly contributed to the dramatic decline of taeniasis/cysticercosis in China.

To intervene or not to intervene: A case of symptomatic neurocysticercosis complicated by ventriculitis

Although well described in the current literature, Neurocysticercosis [NCC] remains an enigma when confronted by practitioners. This is in part due to the haphazard nature of the parasitic infection on the central nervous system [CNS]. These include single or multiple anatomic sites of infection, stage of parasitosis, and the resultant inflammatory response. As a result, NCC can present with a complex constellation of symptomatic presentations, making therapeutic regiments highly individualized. Despite intervention, other impediments may arise post-therapy due to the nature of the infection. We present a case of rapidly progressive symptomatic NCC that initially was successfully treated, however would eventually succumb to complications of ventriculitis.

Human Neurocysticercosis: An Overview

Human cysticercosis is caused by ingestion of T. solium eggs from taenia carriers. Neurocysticercosis (NCC), defined as the infection of the CNS and the meninges by the larval stage of Taenia solium, is the most common helminthic infection of the CNS worldwide. Parasites may lodge in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing pathological changes that account for the pleomorphism of this disease. Seizures/epilepsy are the most common clinical manifestation, but other patients present with headache, focal deficits, intracranial hypertension, or cognitive decline. Accurate diagnosis of NCC is possible after interpretation of clinical data together with findings of neuroimaging studies and results of immunological tests. However, neuroimaging studies are fundamental for diagnosis because immunological test and clinical manifestations only provide circumstantial evidence of NCC. The introduction of cysticidal drugs changed the prognosis of most NCC patients. These drugs have been shown to reduce the burden of infection and to improve the clinical course of the disease in many patients. Efforts should be directed to eradicate the disease through the implementation of control programs against all the steps in the life cycle of T. solium, including carriers of the adult tapeworm, infected pigs, and eggs in the environment.

Hydrocephaly and secondary intracranial hypertension to racemosa neurocysticercosis

Case reportG.F.M, 71 years old, male, farmer, presented a history of holocranial headache of a pulsatile type, more intense on waking, and associated with photophobia. The complaint lasted six months. He also reported episodes of tinnitus and unilateral hearing loss on the left. After conducting screening tests in the emergency department, communicating hydrocephalus and cystic lesions were found in the subarachnoid and intraparenchymal space. In the neurological examination, the positive data were bilateral papilledema and hearing loss in the left boné conduction. Given these findings, the racemous variant of neurocysticercosis and secondary hydrocephalus was suspected, causing intracranial hypertension. Thus, it was decided to start specific treatment with albendazole 15 mg/kg/day (two daily doses), associated with praziquantel 50 mg/kg/day (three daily doses), for 14 days. To reduce the inflammatory process of the lesions, it was proposed to keep the patient on dexamethasone 8 mg/day for 90 days. In addition to this scheme, topiramate 100 mg/day associated with acetazolamide 1 g/day was started, along with serial lumbar puncture to relieve intracranial pressure. ConclusionThe combination of modern diagnostic tests, use of antiparasitic drugs, optimization of anti-inflammatory treatments and minimally invasive neurosurgical procedures have improved results in patients with NCC. Even so, this is the helminth infection that most affects the CNS and represents a major public health problem in most parts of the world, since it remains a neglected pathology, like so many other parasites, given that it is susceptible to containment through simple preventive actions as well as eradication.  

Central Nervous System Miliary Brain Metastasis Secondary to Breast Cancer

Miliary metastasis to the central nervous system (CNS) is a rare presentation of metastasis mainly found in primary adenocarcinoma of the lung. Its association with breast cancer is even less frequent. We present the case of a 50-year-old female patient diagnosed in 2010 with stage IIA infiltrating ductal breast cancer RE (-), RP (+), HER 2 (-), HER2 NEU (+). She was treated with modified radical left breast mastectomy, radiation therapy, and chemotherapy. Her condition began presenting oppressive frontal headache without irradiation, predominantly in the evening, intensity 8/10, which decreased when sleeping and was exacerbated with stressful situations, in addition to progressive cognitive deterioration. Simple and contrasted computed tomography (CT) of the skull and thoracoabdominal were requested, showing multiple micronodular lesions with calcium density in the brain parenchyma, left pleural effusion, hypo and hyperdense lesions in the liver parenchyma, as well as osteoblastic lesions in the lumbar spine. Simple and contrasted magnetic resonance imaging (MRI) of the skull showed multiple supra and infratentorial intra-axial lesions. The most frequent associated symptom with miliary metastasis is cognitive impairment. Miliary metastasis, confirmed by imaging studies and histopathology, requires the ruling out of other causes of this calcification pattern, such as neurocysticercosis, due to specific treatment for each pathology.

Taenia solium Cysticercosis and Its Impact in Neurological Disease

Taenia solium neurocysticercosis (NCC) is endemic in most of the world and contributes significantly to the burden of epilepsy and other neurological morbidity. Also present in developed countries because of immigration and travel, NCC is one of few diseases targeted for eradication. This paper reviews all aspects of its life cycle (taeniasis, porcine cysticercosis, human cysticercosis), with a focus on recent advances in its diagnosis, management, and control. Diagnosis of taeniasis is limited by poor availability of immunological or molecular assays. Diagnosis of NCC rests on neuroimaging findings, supported by serological assays. The treatment of NCC should be approached in the context of the particular type of infection (intra- or extraparenchymal; number, location, and stage of lesions) and has evolved toward combined symptomatic and antiparasitic management, with particular attention to modulating inflammation. Research on NCC and particularly the use of recently available genome data and animal models of infection should help to elucidate mechanisms of brain inflammation, damage, and epileptogenesis.