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MRI images of cysts inside brain ventricles. The fourth ventricle is the most common site for ventricular neurocysticercosis. A large cyst (*) in the fourth ventricle (A) resulted in perilesional edema (arrows) in the patient's posterior fossa (B). The lateral ventricles are also common sites of cyst location (C). Meningeal enhancement (arrowheads) is in a patient with a cyst (*) inside the left lateral ventricle. In some patients, multiple ventricles can be compromised. D, Cysts in the left lateral (arrow) and fourth (*) ventricles of a patient. doi:10.1371/journal.pntd.0005115.g005
Source publication
Extraparenchymal neurocysticercosis has an aggressive course because cysts in the cere-brospinal fluid compartments induce acute inflammatory reactions. The relationships between symptoms, imaging findings, lesion type and location remain poorly understood. In this retrospective clinical records-based study, we describe the clinical symptoms, magne...
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Citations
... In parenchymal neurocysticercosis, the main clinical manifestation is seizures [18], resulting from inflammation caused by the cysticercus, which progresses with parenchymal irritation [19]. In extraparenchymal infection, cysticerci can cause intracranial hypertension with hemiparesis, hydrocephalus, partial seizures, and focal neurological signs due to obstruction of cerebrospinal fluid flow or a strong inflammatory reaction, and if not properly treated, it can lead to death and disability [20]. The prevalence of extraparenchymal NCC is still not well understood, but it is a condition with a poor prognosis, and the mortality rate ranges from 20% to 50% of affected patients [21]. ...
... For the diagnosis of neurocysticercosis, neuroimaging examinations such as computed tomography (CT) and magnetic resonance imaging (MRI) are necessary [4,20], with the latter being more sensitive as it allows for better recognition of parasites, unlike CT which is better at detecting calcifications [22]. Serological tests [4], as well as the analysis of cerebrospinal fluid (CSF) data, are also crucial to confirm neural infection [23,24]. ...
... The described clinical case exemplifies a presentation of extraparenchymal neurocysticercosis, specifically involving the subarachnoid space. This form of NCC is considered more severe than its parenchymal counterpart, with a correspondingly unfavorable prognosis [20]. In general, the subarachnoid type can result in permanent hydrocephalus, entrapment of intracranial nerves, or cerebrovascular complications [39]. ...
Neurocysticercosis, a parasitic infection of the central nervous system (CNS), is a significant public health issue globally, including in Brazil. This article presents a case report of a 44-year-old male patient residing in the rural area of Roraima, the northernmost region of Brazil within the Amazon Forest. The patient, with chronic HIV infection, acquired the Taenia solium helminth, resulting in neurocysticercosis development. Remarkably, the diagnosis of neurocysticercosis was not initially apparent but emerged through meticulous analysis following a motorcycle accident. The absence of seizures, a common clinical manifestation, complicated the diagnostic process, making it an uncommon case of NCC, which may be related to co-infection. As the patient’s condition progressed, multiple complications arose, requiring additional medical attention and interventions. This case underscores the immense challenges faced by healthcare teams in managing neurocysticercosis effectively. It emphasizes the critical need for a comprehensive, multidisciplinary approach to provide optimal care for such complex cases. The study’s findings underscore the importance of raising awareness and implementing improved strategies for tackling neurocysticercosis, particularly in regions where it remains a prevalent concern.
... Studies on VP shunts for hydrocephalus in NCC have highly heterogeneous results. With respect to symptom resolution, rates of success vary from 20 to 90% [33,34], and the need for further surgical procedures varies from 10 to 100% [33,35]. Specifically, regarding shunt malfunction, the reported rates are approximately 50%, with a mean of 1.5 to 3 procedures per patient [36,37]. ...
Neurocysticercosis (NCC) is a common parasitic disease of the central nervous system (CNS) in low-and middle-income countries. The infection is pleomorphic, caused by the larval form of the cestode, Taenia solium, and part of the heterogeneity of its clinical presentations is associated with the localization of the parasite within the CNS. Changes in the current epidemiological trends of NCC indicate that extra-parenchymal NCC is proportionally becoming more frequent. Extraparenchymal NCC is commonly accompanied by raised intracranial hypertension due to hydrocephalus, which is an emergency requiring cyst extirpation by surgical intervention to relieve the symptoms. Although less frequent, parenchymal cysts may also reach giant sizes requiring urgent surgical treatment. Finally, there is an advancement in the comprehension of the association between NCC and epilepsy-and patients with drug-resistant seizures are candidates for surgical treatment. In this narrative review, we summarize the present state of knowledge to update the current trends in the role of surgery in the treatment of NCC.
... Extraparenchymal NCC (EP-NCC), including intraventricular NCC, is one of the most challenging forms of the disease. 2,3 In places with decreasing NCC endemicity, EP-NCC is diagnosed in older ages because of the time elapsed between infection and the onset of symptoms; therefore, the proportion of EP-NCC is rising. [4][5][6] To date, current guidelines for the treatment of NCC have strong recommendations for EP-NCC, although based on a low amount of evidence. ...
... T. solium is one of the seven neglected endemic zoonoses targeted by the WHO, and it is known to be endemic in broad areas of the world, including Latin America, Eastern Europe, sub-Saharan Africa, and parts of Asia, including the Indian subcontinent, Southeast Asia, and large regions of China. [1,2] e endemicity of T. solium is deeply rooted in poverty and involves domestic pig raising and poor sanitary conditions. e burden of neurologic disease associated with continued transmission falls mainly on impoverished rural populations. ...
Background
Neurocysticercosis (NCC) is the most common infestation of the central nervous system, caused by the larval stage of the pig tapeworm Taenia solium . It is prevalent in regions with poor sanitation and underdevelopment, such as Latin America.
Case Description
We present four cases in which they harbored an intraventricular/intraparenchymal, frontal convexity, cerebellomedullary, and intraparenchymal NCC cyst of medium size, respectively. Three of them underwent complete removal of the cyst by craniotomy; the fourth had a shunt for obstructive hydrocephalus first, followed by excision of a suboccipital cyst 8 months later.
Conclusion
The intraventricular/intraparenchymal lesion was more complex to treat than its subarachnoid counterparts because the average brain should be transected and dissected away to achieve total removal. Waterjet dissection, arachnoid microdissection, and cyst drainage allowed minor brain damage than capsule coagulation and traction. Populated prospective studies are needed better to understand the surgical nuances of these rare entities.
... Son HJ [22] reported a higher mean age in Korea than this current study, which was 54.5 ± 12.7 years. The mean age was lower in the study by Bazan et al. [23] who reported a mean age of 40 ± 9.8 years. Whatever the study, it is noted that young adults are more affected by this condition. ...
... presented with motor deficit and language impairment, respectively. This proportion of stroke was similar to that reported by Bazan [23] who mentioned a proportion of 10% and stated that this was the average proportion reported in the literature [29]. The strokes in the current study were all of the ischemic type, in agreement with the cases reported in the literature [2,3,23]. ...
... This proportion of stroke was similar to that reported by Bazan [23] who mentioned a proportion of 10% and stated that this was the average proportion reported in the literature [29]. The strokes in the current study were all of the ischemic type, in agreement with the cases reported in the literature [2,3,23]. These patients had other cardiovascular risk factors that could explain the occurrence of this stroke event, as shown by the non-significance of the statistical test. ...
... Even though it is a relatively rare disease, it is not uncommon to deal with extraparenchymal NCC in the neurosurgical practice in developing countries [5,6]. There are many uncertainties in the management of patients with NCC that are frequently submitted to multiple interventions and shunt revisions [7]. ...
... Rights reserved. Table 2 Recommendations on management of extraparenchymal NCC [4,6,21] a Microsurgical resection might be challenging due to the intense inflammatory reaction caused by the cysts. The arachnoiditis caused by the lesions might involve the main arterial branches of the intracranial circulation and perforators that limit the surgical resection. ...
Purpose
Neurocysticercosis (NCC) is considered a neglected infectious disease, but the most common parasitic disease of the central nervous system (CNS). Due to oral tendencies in childhood, it is hypothesized that individuals are infected around this age and develop symptoms as lately as during young adulthood. Although it is considered a benign disease, it may cause great impact in the patient’s quality of life due to epilepsy, visual symptoms, and hydrocephalus, which eventually requires frequent hospitalizations. The treatment of hydrocephalus is the main challenge for neurosurgeons.
Methods
We performed a concise review on neurocysticercosis in children and the main presentations of NCC in the neurosurgery practice and a systematic review on hydrocephalus secondary to extraparenchymal NCC.
Results
Our review showed a rate of complete resolution of hydrocephalus secondary to NCC of around 80% with the first attempt of surgical treatment combined with medication therapy. Endoscopic removal of the intraventricular cysts with third ventriculostomy was the most common treatment modality. Patients previously managed with ventricular shunts are likely to have worse outcomes and complications.
Conclusion
Endoscopic approach is the gold standard surgical treatment for hydrocephalus secondary to neurocysticercosis.
... The location and morphology of the cysts, the infection burden, the stage of cysts, and the surrounding inflammation can be revealed by CT and MRI. The scolex of cysticercus is rarely visible on CT or conventional MRI sequences, but can be found in apparent diffusion coefficient images and diffusionweighted maps [3]. Pathological examination of diseased tissues to find parasites is the gold standard for diagnosis of cysticercosis. ...
Background
Cysticercosis is the commonest parasitic disease to affect the central nervous system (CNS). However, cysticercosis affecting the spine is extremely rare. We reported a rare case of cysticercosis involving the whole spinal canal in China.
Case Presentation
A rare case of cysticercosis involving the entire spinal cord, in a 52-year-old Chinese man, was detected in 2021. Epidemiological investigation, clinical and etiological examination was performed.
Conclusion
Since spinal cysticercosis is a rare but potentially life-threatening disease, clinicians should always consider the differential diagnosis of space-occupying lesions.
... Neurocysticercosis (NC) is the most common parasitic disease of the central nervous system (CNS) worldwide. Cysticercosis is endemic in most Latin American countries, large regions of Asia including the Indian subcontinent, most of Southeast Asia and China, sub-Saharan Africa, and some countries of Eastern Europe 1 , with most cases coming from rural areas and with an overall prevalence of 8.55% in Colombia [1][2][3][4][5] . After accidental ingestion of Taenia solium eggs (oncospheres), cysticerci hatch in the small intestine, penetrate into the intestinal wall and spread to other tissues through the bloodstream 4 . ...
... Once in the CNS, they can develop to the larval stage. An inflammatory response usually occurs which is more intense after the larval degeneration [1][2][3][4] . ...
Taenia solium is the most common parasitic infection of the central nervous system and it can cause parenchymal or extra-parenchymal lesions. Subarachnoid cysticercosis is a type of extra-parenchymal infection in which the prevalence is not known and racemose NC with cerebellar involvement has been rarely reported. The diagnosis is challenging because of its similarity to other infectious diseases or to subarachnoid involvement of systemic malignancies. Treatment usually requires cysticide drugs, however, there are no randomized studies concerning the anti-parasitic treatment in subarachnoid NC. We present a case of racemose NC in the cerebellar hemisphere to draw attention to this pathology, endemic in many parts of the world; and highlight all the current gaps in our understanding of this entity.
... Therefore these cysts can cause lifethreatening medical conditions such as stroke and intracranial hypertension. 5 Another problem with this presentation is its diagnostic difficulty, particularly because the parasites produce an I. Murrieta et al. intensity signal similar to that of the CSF and this makes their visualization difficult. However, it has been shown that the use of three-dimensional magnetic resonance imaging (MRI) sequences such as fast imaging employing steady-state acquisition (FIESTA) increases the sensitivity of MRI diagnosis. ...
Background:
In patients affected by neurocysticercosis (NCC), the extraparenchymal location of the parasites generates the most severe form of the disease. Due to the difficulty in its diagnosis and management, there are still many questions; in particular, the natural history of parasites at this location is not well known.
Methods:
We included 21 patients with vesicular extraparenchymal NCC who had not received treatment for at least 18 months. We collected their demographic and clinical data, compared their imaging studies at the beginning and the end of the period without treatment and classified the patients, taking into account the evolution of their parasitic burden.
Results:
A total of 10 men and 11 women were included. Patients had undergone a period of 63±48 months without treatment. During this period, 8 patients (38.1%) showed an increase, 7 (33.3%) a decrease and 6 (28.6%) showed no change in parasite burden.
Conclusion:
The natural history of extraparenchymal cysticerci is heterogeneous. The results show the ability of parasites to survive for a long time in the extraparenchymal location and explain the chronicity of the disease in some patients. The links between these findings and the difficulties in the therapeutic management of extraparenchymal NCC patients should be studied.
... 4 In the extraparenchymal form of the disease, the cysts of the tapeworm Taenia solium lodge in the cerebrospinal fluid (CSF) compartments and may cause meningitis, vasculitis, hydrocephalus, and raised intracranial pressure. 5,6 Hydrocephalus is one of the most devastating complications related to extraparenchymal NC. The high rate of infections and malfunctions of the ventricular shunts used to release hydrocephalus in patients with NC are the leading causes of the considerably high mortality in these patients. ...
Purpose Experimental models might help understand the pathophysiology of neurocysticercosis-associated hydrocephalus. The present study aimed to compare the extent of hydrocephalus and tissue damage in rats with subarachnoid inoculation of different concentrations of Taenia crassiceps cyst proteins.
Methods Sixty young rats were divided into two groups: low- and high-concentration groups. The animals in the low concentration group received 0.02 ml of 2.4 mg/ml T. crassiceps cyst proteins while those in the high concentration group received 0.02 ml of 11.6 mg/ml T. crassiceps cyst proteins. The animals underwent magnetic resonance imaging at 1, 3, and 6 months postinoculation to assess the ventricle volume. Morphological assessment was performed at the end of the observation period.
Results Repeated measures of ventricle volumes at 1, 3, and 6 months showed progressive enlargement of the ventricles. At 1 and 3 months, we observed no differences in ventricle volumes between the 2 groups. However, at 6 months, the ventricles were larger in the high concentration group (median = 3.86 mm3, range: 2.37–12.68) compared with the low concentration group (median = 2.00 mm3, range: 0.37–11.57), p = 0.003. The morphological assessment revealed a few inflammatory features in both groups. However, the density of oligodendrocytes and neurons within the periventricular region was lower in the high concentration group (5.18 versus 9.72 for oligodendrocytes and 15.69 versus 21.00 for neurons; p < 0.001 for both).
Conclusion Our results suggest that, in rats, a higher concentration of T. crassiceps cyst proteins in the subarachnoid space could induce ventricle enlargement and reduce the number of neurons within the periventricular area.
