Cysticercosis: the pork parasite

13 Mar

Cysticercosis!

caused by the larval stage (metacestode) of the pork tapeworm Taenia solium.

  • neurocysticercosis (NCC)
    • parenchymal
    • extraparenchymal  
      • intraventricular,
      • subarachnoid,
      • intraocular,
      • spinal disease.
  • extraneural cysticercosis, e.g…
    • skeletal muscles
    • skin
    • eyes
    • heart

 

Tissue cysticerci develop over a period of three to eight weeks following ingestion of T. solium eggs shed in the stool of a human tapeworm carrier.   

 

clinical manifestations

  • depend upon location (brain parenchyma vs extraparenchymal tissues, or both)
  • parenchymal cysts – seizures (70-90% of pts), headache
  • extraparenchymal cysts – elevated intracranial pressure (e.g. headache, nausea/vomiting, AMS)
  • less common manifestations include
    • mass effect,
    • altered vision,
    • focal neurologic signs,
    • altered mental status,
    • meningitis.
  • Fever is not typically present.

 

  • Neuro exam usually non-focal in the absence of mass effect or stroke. 
  • CT scan is excellent for detecting calcifications, MRI sometimes helpful
  • Serologic testing (BUT negative serology does not exclude the diagnosis)

 

TREATMENT:

  • antiepileptics for seizures.  
  • antiparasitic drugs (pts have slightly shorter duration of seizure risk and time to radiologic resolution)
    • albendazole 
    • praziquantel 
  • +/- steroids
  • +/- surgical removal

 

Submitted by Heather Reed-Day.

 

References: Randeva HS, Davison R., Chamoun V., Boulox P.. Isolated neurosarcoidosis—a diagnostic enigmaEndocrine. 2002;17(3):241–47.; CDC reference; picture

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