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---
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title: "Neurocysticercosis"
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docid: "d518dff8-cc30-46e5-8894-3926e6b987cf"
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authors:
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- key: "b2e6dabb-ee1c-42a4-a332-9f0814c1c607"
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value: "Surjith Vattoth, MD, FRCR"
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breadcrumbs:
|
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-
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name: "Pediatrics"
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slug: "pediatrics"
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treeNodeId: "a915965c-d436-44cf-ae65-2f22e7246ea4"
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-
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name: "Diagnosis"
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slug: "diagnosis"
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treeNodeId: "2b5cea64-a083-489e-ac0c-ec14ba059026"
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-
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name: "Pediatric Neuroradiology"
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slug: "pediatric-neuroradiology"
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treeNodeId: "d0eb8f4a-e769-43dd-896c-8c9c27ce8759"
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-
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name: "Brain"
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slug: "brain"
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treeNodeId: "feaaadba-649b-4f0a-9aad-9188a8f9926a"
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-
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name: "Pathology-Based Diagnoses"
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slug: "pathology-based-diagnoses"
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treeNodeId: "2d26053f-23a7-4062-bf35-a93775ae1209"
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-
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name: "Infectious Disease"
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slug: "infectious-disease"
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treeNodeId: "fa351336-02de-4a91-82fd-6d7571183f2c"
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-
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name: "Acquired Infections"
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slug: "acquired-infections"
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treeNodeId: "66e78732-b12d-46e3-8559-5fe93a700a29"
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-
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name: "Neurocysticercosis"
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slug: "neurocysticercosis"
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treeNodeId: null
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category: "Pediatrics"
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cmeTopicId: "c949d06e-22c1-4d98-a0ae-20386c7ac00c"
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documentVersionId: "3586f0c9-5e87-4e72-b0a1-df72f68ca113"
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imageCount: 27
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lastUpdated: "02/14/24"
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pageDescription: "Neurocysticercosis"
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pageKeywords: "Pediatrics, Diagnosis, Pediatric Neuroradiology, Brain, Pathology-Based Diagnoses, Infectious Disease, Acquired Infections, Neurocysticercosis"
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pageTitle: "Neurocysticercosis | STATdx"
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enhancedTitle: "Neurocysticercosis"
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type: "DX"
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references: true
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breadcrumbs:
|
||||
- "Pediatrics"
|
||||
- "Diagnosis"
|
||||
- "Pediatric Neuroradiology"
|
||||
- "Brain"
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||||
- "Pathology-Based Diagnoses"
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||||
- "Infectious Disease"
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||||
- "Acquired Infections"
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||||
- "Neurocysticercosis"
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---
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# KEY FACTS
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- ## Terminology
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- Neurocysticercosis (NCC): Intracranial parasitic infection caused by pork tapeworm *Taenia solium*
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- ## Imaging
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- Best diagnostic clue: Cyst with "dot" inside
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- Convexity **subarachnoid spaces** most common location
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- Inflammatory response around cyst may **seal sulcus**, making lesions **appear intraaxial**
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- May involve cisterns > parenchyma > ventricles
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- Intraventricular cysts often isolated, 4th > 3rd ventricle
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- **Racemose** (grape-like) NCC: In basal cisterns; no scolex
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- Imaging varies with development stage & host response
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- Lesions may be at different stages in same patient
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- FLAIR & T1 MR helpful to identify scolex & intraventricular lesions
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- GRE/SWI helpful in young adults presenting with seizures
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- In children, may see "**encephalitic cysticercosis**": Multiple small, enhancing lesions (starry-sky) & diffuse edema
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- ## Top Differential Diagnoses
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- Abscess, tuberculosis, neoplasm
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- Epidermoid/arachnoid cyst (racemose NCC differential)
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- Toxoplasmosis, enlarged perivascular spaces
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- ## Pathology
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- 4 pathologic stages (2 vesicular & 2 nodular)
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- Vesicular, colloidal vesicular, granular nodular, & nodular calcified
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- ## Clinical Issues
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- Seizures, headaches, hydrocephalus common
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- NCC asymptomatic until larvae degenerate
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- Cysticercosis most common parasitic infection worldwide
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- CNS involved in 60-90% of cysticercosis cases
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- Most common cause of epilepsy in endemic areas
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- Increased travel, immigration have spread disease
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- Diagnosis confirmed by ELISA of serum or CSF
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- Oral albendazole (reduces parasitic burden, seizures)
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- Steroids often required to decrease edema
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- Consider excision or drainage of parenchymal lesions
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- ## Diagnostic Checklist
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- Cyst with scolex & calcific foci in patients in endemic areas
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# TERMINOLOGY
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- ## Abbreviations
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- Neurocysticercosis (NCC)
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- ## Synonyms
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- Cysticercosis
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- ## Definitions
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- Intracranial parasitic infection caused by pork tapeworm *Taenia solium*; 4 pathologic stages: 2 vesicular & 2 nodular
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- Vesicular, colloidal vesicular, granular nodular, & nodular calcified
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# IMAGING
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- ## General Features
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- ### Best diagnostic clue
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- Cyst with "dot" (scolex) inside
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- ### Location
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- Convexity **subarachnoid spaces** most common
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- May involve cisterns > parenchyma > ventricles
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- Parenchymal cysts often at gray-white junction
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- Intraventricular cysts are often isolated
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- 4th ventricle most common, then 3rd ventricle
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- May migrate; causes ependymitis & hydrocephalus
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- Basal cistern cysts may be racemose (grape-like)
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- Rare head & neck/CNS locations: Sella, orbit (especially **extraocular muscles**), spinal **cord**
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- Ocular cysticercosis may present at diagnosis or later after commencing cysticidal treatment
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- Other sites: Skeletal/heart muscles, subcutaneous tissue
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- ### Size
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- ~ 1-cm cysts; range: 5-20 mm; scolex (1-4 mm)
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- Parenchymal cysts ≤ 1 cm
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- Subarachnoid cysts may be larger
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- ### Morphology
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- Round or ovoid cyst, solitary in 20-50%
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- When multiple, usually small number of cysts
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- Disseminated form (a.k.a. **miliary NCC**): Rare
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- Imaging varies with development stage & host response
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- Lesions may be at different stages in same patient
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- Inflammatory response around cyst may **seal sulcus**, making lesions **appear intraaxial**
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- In children &, occasionally, adults (usually young females, rarely males), may see "**encephalitic cysticercosis**"
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- Multiple small, enhancing lesions (**starry-sky** appearance) & diffuse edema
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- ## CT Findings
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- ### NECT
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- **Vesicular** stage (viable larva): Smooth, thin-walled cyst, isodense to CSF, no edema
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- Hyperdense "dot" within cyst = protoscolex
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- **Colloidal vesicular** stage (degenerating larva): Hyperdense cyst fluid with surrounding edema
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- **Granular nodular** stage (healing): Mild edema
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- **Nodular calcified** stage (healed): Small, calcified nodule
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- ### CECT
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- **Vesicular** stage: No (or mild) wall enhancement
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- **Colloidal vesicular** stage: Thick, ring-enhancing capsule
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- **Granular nodular**stage: Involuting, enhancing nodule
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- **Nodular calcified**stage: Shrunken, Ca⁺⁺ nodule
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- Intraventricular cysts not well seen on CT
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- Subarachnoid NCC: Multiple isodense cysts without scolex; may cause meningitis, vasculitis, or hydrocephalus
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- ## MR Findings
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- ### T1WI
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- **Vesicular** stage: Cystic lesion isointense to CSF
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- May see discrete, eccentric scolex (hyperintense)
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- **Colloidal vesicular** stage: Cyst mildly hyperintense
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- **Granular nodular** stage: Thickened, retracted cyst wall; edema ↓
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- **Nodular calcified** stage: Shrunken, Ca⁺⁺ lesion
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- Useful to detect intraventricular cysts
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- ### T2WI
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- **Vesicular** stage: Cystic lesion isointense to CSF
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- May see discrete, eccentric scolex
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- No surrounding edema
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- **Colloidal vesicular** stage: Cyst hyperintense
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- Surrounding edema, mild to marked
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- **Granular nodular**stage: Thickened, retracted cyst wall; edema ↓
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- **Nodular calcified** stage: Shrunken, Ca⁺⁺ lesion
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- ### FLAIR
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- **Vesicular**stage: Cystic lesion isointense to CSF
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- May see discrete, eccentric scolex (hyperintense to CSF); no edema
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- **Colloidal vesicular** stage: Cyst hyperintense
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- Surrounding edema, mild to marked
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- Useful to detect intraventricular cysts (hyperintense)
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- 100% inspired **oxygen ↑**conspicuity
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- **Postcontrast FLAIR** best to detect abnormal meningeal enhancement
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- ### T2* GRE
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- Useful to demonstrate calcified scolex; SWI better
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- May show multiple black dots appearance
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- ### DWI
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- Cystic lesion typically isointense to CSF
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- Scolex detectable as hyperintense nodule
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- ### PWI
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- Ring-enhancing NCC wall shows lower mean rCBV (1.3) compared with tuberculoma wall
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- Tuberculoma: Mild ↑ mean rCBV (2-3.3)
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- Cutoff value of wall rCBV 1.965 for tuberculoma: 90% sensitivity & 100% specificity
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- Core of both tuberculoma & NCC lower rCBV than normal white matter
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- ### T1WI C+
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- **Vesicular** stage: No enhancement typical, may see mild enhancement/eccentric scolex enhancement
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- **Colloidal vesicular** stage: Thick cyst wall enhances
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- Enhancing marginal nodule (scolex)
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- **Granular nodular** stage: Thickened, retracted cyst wall; may have nodular or ring-like enhancement
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- **Nodular calcified** stage: Small calcified lesion, rare minimal enhancement
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- ### MRS
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- ↑ lactate, alanine, succinate, choline; ↓ NAA & Cr
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- Steady-state sequences (CISS) for intraventricular cysts
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- **Cisternal** NCC may appear **racemose** (multilobulated, grape-like), typically **lacks scolex**
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- Complications: Meningitis, hydrocephalus, vasculitis
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- ## Imaging Recommendations
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- ### Best imaging tool
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- MR most sensitive; SWI MR & CT for calcifications
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- Helpful to identify extraparenchymal NCC (intraventricular, subarachnoid)
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- Calcified lesions may be better seen on CT
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- ### Protocol advice
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- MR with T1, T2, FLAIR, GRE/SWI, contrast
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- Thin slices (< 3 mm) to identify scolex
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# DIFFERENTIAL DIAGNOSIS
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- [Abscess](/document/abscess/552b58e6-aa5e-49b4-b9aa-e0413c07bf3c)
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- Typically T2-hypointense rim & **DWI-restricting core**
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- Multiple lesions may occur related to septic emboli
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- [Tuberculosis](/document/tuberculosis/6e389773-2150-4299-9ce2-0b83b13c2119)
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- Tuberculomas often occur with meningitis
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- Nodular stages of NCC mimic tuberculoma
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- ## Neoplasm
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- Primary or metastatic (primary often known)
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- Thick, irregular margin enhancement typical
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- May have cyst & mural nodule (e.g., pilocytic astrocytoma, hemangioblastoma)
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- Metastasis wall show more elevated mean rCBV (5.43)
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- Cut-off value of ≥ 3.745 for differentiating ring-enhancing metastases from tuberculomas
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- [Arachnoid Cyst & Epidermoid Cyst](/document/arachnoid-cyst/d25aaeb3-5b3c-4483-99dc-2757468eedb9)
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- Solitary lesion with CSF density/intensity & no enhancement; racemose NCC differential
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- **Arachnoid cyst**: CSF intensity on T2, FLAIR, & DWI
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- **Epidermoid**: CSF intensity on T2, "dirty" on FLAIR, & shows diffusion restriction on DWI
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- **Racemose NCC**: CSF intensity with septa on T2, "dirty" on FLAIR, but no diffusion restriction on DWI
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- [Enlarged Perivascular Spaces](/document/enlarged-perivascular-spaces/58fff1ec-50b7-4caf-ab31-3341ab7044c9)
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- Follow CSF on all MR sequences, no enhancement
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- [Other Parasitic Infection](/document/miscellaneous-parasites-/435032d5-3ef7-4d88-997a-8f4581b59e5b)
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- **Toxoplasmosis** ring-enhancing cyst with enhancing **eccentric target sign** of nodule mimicking NCC scolex
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- Usually in immunocompromised (e.g., AIDS); differential lymphoma in these patients
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- Basal ganglia common; other multiple lesions can occur
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- Other parasitic cysts, but no scolex seen
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# PATHOLOGY
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- ## General Features
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- ### Etiology
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- Caused by larval form of pork tapeworm*T. solium*
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- Humans **intermediate hosts** in life cycle of tapeworm
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- **Fecal-oral**most common route of infection
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- **Ingestion** of **eggs** from contaminated water, food
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- From GI tract, primary larvae (**oncospheres**) disseminate into CNS & skeletal muscle
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- Once intracranial, primary develop into secondary larvae, **cysticerci**
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- Humans may also be **definitive hosts** (infected with tapeworm): Typically from **undercooked pork**
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- **Viable larvae ingested**, attach in GI tract
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- ## Staging, Grading, & Classification
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- 4 pathologic stages (**2 vesicular** & **2 nodular**)
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- Vesicular, colloidal vesicular, granular nodular, & nodular calcified
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- **Vesicular** stage: Larva small with marginal nodule projecting into small cyst with clear fluid
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- Viable parasite with little or no inflammation
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- May remain in this stage for years or degenerate
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- **Colloidal vesicular** stage: Larva begins to degenerate
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- Scolex shows hyaline degeneration, slowly shrinks
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- Cyst fluid becomes turbid, & capsule thickens
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- Surrounding edema & inflammation
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- **Granular nodular**stage: Cyst wall thickens & scolex mineralized granule; surrounding edema regresses
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- **Nodular calcified**stage: Lesion completely mineralized & small; no edema
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- ## Gross Pathologic & Surgical Features
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- Usually small translucent cyst with invaginated scolex
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- ## Microscopic Features
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- Cyst wall has 3 distinct layers: Outer (cuticular), middle cellular (pseudoepithelial), & inner reticular (fibrillary) layers
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- Scolex has rostellum with hooklets, muscular suckers
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- Variable inflammatory reaction, acute & chronic
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# CLINICAL ISSUES
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- ## Presentation
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- ### Most common signs/symptoms
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- Seizure, headaches, hydrocephalus
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- Varies with organism development stage, host immune response
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- NCC asymptomatic until larvae degenerate
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- Other signs/symptoms: Syncope, dementia, visual changes, focal neurologic deficits, stroke
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- ### Clinical profile
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- Diagnosis confirmed by ELISA of serum or CSF
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- Serologic tests may cross react with *Echinococcus*
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- CSF studies abnormal in 50%, ↑ lymphocytes
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- ## Demographics
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- ### Epidemiology
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- Cysticercosis most common parasitic infection
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- CNS infection in 60-90% of cysticercosis cases
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- Endemic in many countries (Latin America, parts of Asia, India, Africa, Eastern Europe)
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- USA: Incidence ↑ in CA, AZ, NM, TX
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- ↑ travel, immigration have spread disease
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- Age: Any; commonly young, middle-aged adults
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- Sex: Slight male predominance
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- Ethnicity: In USA, Latin American patients common
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- ## Natural History & Prognosis
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- Most common cause of **epilepsy** in endemic areas
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- Variable time from initial infection until symptoms: 6 months to 30 years; typically 2-5 years
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- Variable time to progress through pathologic stages: 1-9 years; mean: 5 years
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- Subarachnoid disease may be complicated by meningitis, vasculitis, & hydrocephalus
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- Intraventricular NCC has ↑ morbidity & mortality (↑ morbidity related to **acute hydrocephalus**)
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- High association of NCC **coinfection** with **Japanese encephalitis (JE)**
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- JE lesions asymmetrically more at ipsilateral side of brain with more NCC lesions or NCC cyst with edema
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- JE lesions in coinfections more florid, more common in children, & patients show altered immune status
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- ## Treatment
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- Oral albendazole (reduces parasitic burden, seizures)
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- Albendazole along with praziquantel if > 2 viable cysts
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- Steroids often required to ↓ edema
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- Consider excision or drainage of parenchymal lesions
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- Consider endoscopic resection of ventricular lesions
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- CSF diversion often required to treat hydrocephalus
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- Cysticidal agents contraindicated in patients with encephalitic cysticercosis
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- **Encephalitic cysticercosis** in those without prior exposure, newly infected with heavy load *T. solium* eggs
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- Host immune system react actively: Acute encephalitis with multiple degenerating cysticerci & swollen brain
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- Antiparasitic drugs not needed, as most parasites die spontaneously from host response
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- Drugs can exacerbate inflammatory reaction turning harmful to patients
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- If antihelminthic drugs used, give under steroid cover
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# DIAGNOSTIC CHECKLIST
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- ## Consider
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- Complex parasitic cysts may mimic brain tumor
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- ## Image Interpretation Pearls
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- Cyst with scolex & calcific foci in patients in endemic areas
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- FLAIR & T1WI helpful to identify scolex & intraventricular lesions
|
||||
- GRE/SWI helpful in young adults presenting with seizures
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||||
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8b196bce-9146-4120-82e0-0b8ac0372b2c
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## References
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# Selected References
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|
||||
1. [Sakhuja A et al: Severe Neurocysticercosis in an immunocompetent male without travel to an endemic region: a case report. Cureus. 15(2):e34870, 2023](http://www.ncbi.nlm.nih.gov/pubmed/?term=36923196%5Bpmid%5D)
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1. [Ghosal A et al: Nightmares with a starry sky - treating neurocysticercal encephalitis, how far to go. Trop Parasitol. 10(2):158-62, 2020](http://www.ncbi.nlm.nih.gov/pubmed/?term=33747887%5Bpmid%5D)
|
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1. [Arroyo G et al: Albendazole sulfoxide plasma levels and efficacy of antiparasitic treatment in patients with parenchymal neurocysticercosis. Clin Infect Dis. 69(11):1996-2002, 2019](http://www.ncbi.nlm.nih.gov/pubmed/?term=30715265%5Bpmid%5D)
|
||||
1. [Ghosh RN et al: Perfusion magnetic resonance imaging in differentiation of neurocysticercosis and tuberculoma. Neuroradiology. 61(3):257-63, 2018](http://www.ncbi.nlm.nih.gov/pubmed/?term=30377746%5Bpmid%5D)
|
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1. [Rodrigues A et al: A classic neurocysticercosis case with an unusual complication. Eur J Case Rep Intern Med. 5(1):000762, 2018](http://www.ncbi.nlm.nih.gov/pubmed/?term=30755977%5Bpmid%5D)
|
||||
1. [Del Brutto OH: Neurocysticercosis. Handb Clin Neurol. 121:1445-59, 2014](http://www.ncbi.nlm.nih.gov/pubmed/?term=24365429%5Bpmid%5D)
|
||||
1. [Hernández RD et al: Magnetic resonance imaging in neurocysticercosis. Top Magn Reson Imaging. 23(3):191-8, 2014](http://www.ncbi.nlm.nih.gov/pubmed/?term=24887694%5Bpmid%5D)
|
||||
1. [Bhattacharjee S et al: Clinical profile and follow-up of 51 pediatric neurocysticercosis cases: a study from Eastern India. Ann Indian Acad Neurol. 16(4):549-55, 2013](http://www.ncbi.nlm.nih.gov/pubmed/?term=24339577%5Bpmid%5D)
|
||||
1. [Carpio A et al: Neurocysticercosis: five new things. Neurol Clin Pract. 3(2):118-25, 2013](http://www.ncbi.nlm.nih.gov/pubmed/?term=23914321%5Bpmid%5D)
|
||||
1. [Cuello-García CA et al: Corticosteroids for neurocysticercosis: a systematic review and meta-analysis of randomized controlled trials. Int J Infect Dis. 17(8):e583-92, 2013](http://www.ncbi.nlm.nih.gov/pubmed/?term=23339852%5Bpmid%5D)
|
||||
1. [Souza Ad et al: Solitary cerebral parenchymal cysticercosis: a prospective comparative study with computed tomography and magnetic resonance imaging. Neurol India. 61(6):639-43, 2013](http://www.ncbi.nlm.nih.gov/pubmed/?term=24441333%5Bpmid%5D)
|
||||
1. [Lerner A et al: Imaging of neurocysticercosis. Neuroimaging Clin N Am. 22(4):659-76, 2012](http://www.ncbi.nlm.nih.gov/pubmed/?term=23122261%5Bpmid%5D)
|
||||
1. [Sinha S et al: Intraventricular neurocysticercosis: a review of current status and management issues. Br J Neurosurg. 26(3):305-9, 2012](http://www.ncbi.nlm.nih.gov/pubmed/?term=22168964%5Bpmid%5D)
|
||||
1. [Matushita H et al: Hydrocephalus in neurocysticercosis. Childs Nerv Syst. 27(10):1709-21, 2011](http://www.ncbi.nlm.nih.gov/pubmed/?term=21928035%5Bpmid%5D)
|
||||
1. [Angeles CF et al: Transventricular neuroendoscopic excision of giant racemose subarachnoid cysticercosis. Childs Nerv Syst. 25(4):503-8, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=19212776%5Bpmid%5D)
|
||||
1. [Sinha S et al: Neurocysticercosis: a review of current status and management. J Clin Neurosci. 16(7):867-76, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=19394828%5Bpmid%5D)
|
||||
1. [Goel RK et al: Endoscopic management of intraventricular neurocysticercosis. J Clin Neurosci. 15(10):1096-101, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=18653345%5Bpmid%5D)
|
||||
1. [Handique SK et al: Coinfection of Japanese encephalitis with neurocysticercosis: an imaging study. AJNR Am J Neuroradiol. 29(1):170-5, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=17928378%5Bpmid%5D)
|
||||
1. [Jimenez-Vazquez OH et al: Cisternal neurocysticercosis. Br J Neurosurg. 22(6):774-5, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=19085362%5Bpmid%5D)
|
||||
1. [Jung H et al: Medical treatment for neurocysticercosis: drugs, indications and perspectives. Curr Top Med Chem. 8(5):424-33, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=18393906%5Bpmid%5D)
|
||||
1. [Kraft R: Cysticercosis: an emerging parasitic disease. Am Fam Physician. 2007 Jul 1;76(1):91-6. Review. Erratum in: Am Fam Physician. 77(6):748, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=17668846%5Bpmid%5D)
|
||||
1. [Odermatt P et al: Treatment of neurocysticercosis: a randomised controlled trial. J Neurol Neurosurg Psychiatry. 79(9):978, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=18708566%5Bpmid%5D)
|
||||
1. [Kwee RM et al: Virchow-Robin spaces at MR imaging. Radiographics. 27(4):1071-86, 2007](http://www.ncbi.nlm.nih.gov/pubmed/?term=17620468%5Bpmid%5D)
|
||||
1. [Lucato LT et al: The role of conventional MR imaging sequences in the evaluation of neurocysticercosis: impact on characterization of the scolex and lesion burden. AJNR Am J Neuroradiol. 28(8):1501-4, 2007](http://www.ncbi.nlm.nih.gov/pubmed/?term=17846200%5Bpmid%5D)
|
||||
1. [Mathews M et al: Intraventricular cryptococcal cysts masquerading as racemose neurocysticercosis. Surg Neurol. 67(6):647-9, 2007](http://www.ncbi.nlm.nih.gov/pubmed/?term=17512347%5Bpmid%5D)
|
||||
1. [Bhigjee AI et al: Optimizing therapy of seizures in patients with HIV and cysticercosis. Neurology. 67(12 Suppl 4):S19-22, 2006](http://www.ncbi.nlm.nih.gov/pubmed/?term=17190916%5Bpmid%5D)
|
||||
1. [Reddy JS et al: The role of diffusion-weighted imaging in the differential diagnosis of intracranial cystic mass lesions: a report of 147 lesions. Surg Neurol. 66(3):246-50; discussion 250-1, 2006](http://www.ncbi.nlm.nih.gov/pubmed/?term=16935625%5Bpmid%5D)
|
||||
1. [Sáenz B et al: Neurocysticercosis: clinical, radiologic, and inflammatory differences between children and adults. Pediatr Infect Dis J. 25(9):801-3, 2006](http://www.ncbi.nlm.nih.gov/pubmed/?term=16940837%5Bpmid%5D)
|
||||
1. [Velasco TR et al: Calcified cysticercotic lesions and intractable epilepsy: a cross sectional study of 512 patients. J Neurol Neurosurg Psychiatry. 77(4):485-8, 2006](http://www.ncbi.nlm.nih.gov/pubmed/?term=16543527%5Bpmid%5D)
|
||||
1. [Jayakumar PN et al: MRI and in vivo proton MR spectroscopy in a racemose cysticercal cyst of the brain. Neuroradiology. 46(1):72-4, 2004](http://www.ncbi.nlm.nih.gov/pubmed/?term=14614578%5Bpmid%5D)
|
||||
1. [Garcia HH et al: Taenia solium cysticercosis. Lancet. 362(9383):547-56, 2003](http://www.ncbi.nlm.nih.gov/pubmed/?term=12932389%5Bpmid%5D)
|
||||
1. [Zee CS et al: Imaging of neurocysticercosis. Neuroimaging Clin N Am. 10(2):391-407, 2000](http://www.ncbi.nlm.nih.gov/pubmed/?term=10775958%5Bpmid%5D)
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## Images
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### Selected Images
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|
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|
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*Coronal graphic shows subarachnoid & ventricular neurocysticercosis (NCC). Convexity cysts have a scolex and surrounding inflammation. Note that inflammation around the largest cyst "seals" the sulcus <img src='img/arrows/BS.png'/>, making it appear parenchymal. Racemose cysts <img src='img/arrows/BO.png'/> are multilocular, nonviable in the basal cisterns & typically lack scolex.*
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|
||||
|
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*Axial CECT shows bilateral frontoparietal nonenhancing cysts without edema. One left parietal lobe cyst shows hyperdense scolex <img src='img/arrows/BC.png'/>, suggesting NCC vesicular stage.*
|
||||
|
||||
|
||||
*Axial CECT in a young male patient with 1st episode of seizure demonstrates a ring-enhancing lesion <img src='img/arrows/BC.png'/> with an eccentric hyperdense "dot" <img src='img/arrows/BS.png'/> that denotes scolex. Note the edema <img src='img/arrows/BO.png'/> surrounding this colloidal vesicular stage of NCC.*
|
||||
|
||||
|
||||
*Axial postcontrast MR (left) shows a tiny, solidly enhancing nodule in the left cerebellar hemisphere <img src='img/arrows/BO.png'/> due to granular nodular stage of NCC. Axial SWI MR (right) in the same patient shows a blooming hypointense focus in the left frontal lobe <img src='img/arrows/BS.png'/> due to nodular calcified stage of NCC.*
|
||||
|
||||
|
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*Axial NECT in a patient with seizures shows multiple scattered, hyperdense, left more than right frontoparietal lobe calcifications. Perilesional gliosis contributes to the epileptogenicity of nodular calcified NCC.*
|
||||
|
||||
|
||||
*MRS at TR 1500, TE 144 within the cyst cavity of a colloidal vesicular NCC lesion in a patient (not shown) shows peaks of Cho <img src='img/arrows/WS.png'/> (3.2 ppm), succinate <img src='img/arrows/WO.png'/> (2.4 ppm), and lactate <img src='img/arrows/WC.png'/> (1.3 ppm).*
|
||||
|
||||
|
||||
*Axial T1 C+ MR demonstrates multiple cysts in the suprasellar cistern <img src='img/arrows/WS.png'/> and left sylvian fissure <img src='img/arrows/WC.png'/>. There is extensive leptomeningeal enhancement <img src='img/arrows/BC.png'/> in the basal cisterns and sylvian fissures. Cisternal NCC, also termed racemose (grape-like) if multiple cysts without scolex, may cause meningeal inflammation, communicating hydrocephalus, vasculitis, and infarcts.*
|
||||
|
||||
|
||||
*Axial T1 C+ MR in an NCC patient shows a ring-enhancing cyst <img src='img/arrows/BS.png'/> with tiny scolex <img src='img/arrows/BO.png'/> enhancement in the quadrigeminal cistern posterior to the midbrain.*
|
||||
|
||||
|
||||
*Axial T1 C+ MR in a patient with hydrocephalus shows rim-enhancing isolated 4th ventricular NCC <img src='img/arrows/BS.png'/> with enhancing scolex <img src='img/arrows/BO.png'/>.*
|
||||
|
||||
|
||||
*Axial T2WI MR (top left) shows a CSF intensity cyst with septa in prepontine cistern/CP angles <img src='img/arrows/BS.png'/>. Axial postcontrast T1WI MR (top right) shows no enhancement. Axial FLAIR (bottom left) shows a dirty appearance due to incomplete fluid suppression (excluding arachnoid cyst). Axial DWI (bottom right) shows no diffusion restriction (excluding epidermoid). Findings are consistent with racemose NCC.*
|
||||
|
||||
|
||||
### Additional Images
|
||||
|
||||
|
||||
*Gross pathology shows a translucent cyst with a characteristic invaginated white scolex, diagnostic of NCC. This resected lesion came from a seizure patient. (Courtesy B. Cremin, MD.)*
|
||||
|
||||
|
||||
*Axial T1 C+ MR shows an NCC cyst <img src='img/arrows/WO.png'/> with an enhancing nodule in the posterior 3rd ventricle. Note the associated acute obstructive hydrocephalus, a common complication of intraventricular cysts. Intraventricular cysts are often isolated with the 4th ventricle most commonly involved. (Courtesy N. Fischbein, MD.)*
|
||||
|
||||
|
||||
*Axial NECT shows an enlarged 4th ventricle. On this slice, the enlarged temporal horns of the lateral ventricle and anterior recesses of the 3rd ventricle <img src='img/arrows/WS.png'/> are obvious, but the cause for the hydrocephalus is not. NCC in the 4th ventricle is better seen on MR.*
|
||||
|
||||
|
||||
*Axial CECT in a patient with seizures and NCC shows a typical colloidal vesicular-stage cyst with peripheral enhancement and surrounding edema. Note the eccentric scolex <img src='img/arrows/WC.png'/>.*
|
||||
|
||||
|
||||
*Axial CECT in a patient with headaches and seizures shows a ring-enhancing mass with surrounding edema in the frontal lobe <img src='img/arrows/WC.png'/>. A ventricular lesion is present but not well seen <img src='img/arrows/WS.png'/>. Diagnosis was colloidal vesicular-stage NCC.*
|
||||
|
||||
|
||||
*Axial T1WI MR shows the frontal lesion <img src='img/arrows/WC.png'/> and the intraventricular cyst. Note the cyst wall <img src='img/arrows/WO.png'/> and the hyperintense scolex <img src='img/arrows/WS.png'/>. T1WI and FLAIR MR help identify ventricular lesions.*
|
||||
|
||||
|
||||
*Axial CECT shows a right external capsule cyst <img src='img/arrows/WC.png'/> with a central "dot" <img src='img/arrows/WS.png'/> representing a scolex. No edema or enhancement is seen in this patient with vesicular-stage NCC. Note the calcified left putamen nodule, calcified nodular stage <img src='img/arrows/WO.png'/>.*
|
||||
|
||||
|
||||
*Axial T2WI MR shows cysts in the subarachnoid spaces <img src='img/arrows/WS.png'/> filling the sylvian fissure <img src='img/arrows/WO.png'/> and causing mild mass effect on the cerebral peduncle of midbrain with mild edema <img src='img/arrows/WC.png'/> here. Note the lack of a scolex, typical of cisternal racemose NCC.*
|
||||
|
||||
|
||||
*Axial T1WI MR shows innumerable cysts <img src='img/arrows/WS.png'/>, each with a hyperintense scolex <img src='img/arrows/WC.png'/> in this patient from Mexico. This disseminated form of NCC is rare and is seen in patients from endemic areas. Multiple NCC lesions with a starry-sky appearance may also be seen in the extremely rare encephalitic cysticercosis usually in immunocompetent children and young women without prior exposure, who are newly infected with a heavy load Taenia solium eggs. Significant brain edema will be seen in the encephalitic form.*
|
||||
|
||||
|
||||
*Axial FLAIR MR shows a right frontal "mass" in a young adult with new focal seizures. The NCC cyst follows CSF signal <img src='img/arrows/BS.png'/>. Note the surrounding hyperintense edema <img src='img/arrows/WO.png'/>.*
|
||||
|
||||
|
||||
*Axial T1 C+ MR in the same patient shows peripheral enhancement of the cyst wall <img src='img/arrows/WO.png'/> with a central "dot" representing the scolex <img src='img/arrows/WC.png'/>. The surrounding inflammation has caused the overlying sulcus to seal, making the lesion appear intraaxial. Occasionally, linear enhancement may be seen extending from the lesion, representing inflammation along the pial surface of the sulcus.*
|
||||
|
||||
|
||||
*Coronal T1 C+ MR in the same patient shows peripheral enhancement of the NCC cyst (colloidal vesicular stage) <img src='img/arrows/WS.png'/>.*
|
||||
|
||||
|
||||
*Axial CECT shows a ring-enhancing frontal lobe lesion with a central "dot" <img src='img/arrows/WS.png'/> and surrounding edema in this patient with colloidal vesicular NCC. CT often shows calcified lesions to better advantage than MR.*
|
||||
|
||||
|
||||
*Axial T2* GRE MR in this seizure patient shows multifocal "black dots" in the sulci, parenchyma, and right frontal horn related to the nodular calcified stage of NCC <img src='img/arrows/WC.png'/>. It is important to remember that different lesions may be at different stages in the same patient.*
|
||||
|
||||
|
||||
*Axial FLAIR MR shows a 4th ventricular lesion <img src='img/arrows/WO.png'/> related to colloidal vesicular-stage NCC. Note the eccentric scolex <img src='img/arrows/WS.png'/>. FLAIR and T1 are the best MR sequences to identify intraventricular lesions, which are often complicated by acute hydrocephalus.*
|
||||
|
||||
|
||||
*Sagittal STIR MR shows multiple hyperintense cysts in the quadrigeminal cistern <img src='img/arrows/WO.png'/> and basal subarachnoid spaces <img src='img/arrows/WS.png'/> related to racemose NCC. Note the typical lack of a scolex. (Courtesy E. Bravo, MD.)*
|
||||
|
||||
|
||||
*Sagittal FIESTA MR shows hydrocephalus due to intraventricular NCC cysts <img src='img/arrows/BC.png'/> blocking CSF flow from the 3rd ventricle to the aqueduct.*
|
||||
|
||||
Reference in New Issue
Block a user