Figure 1. A. Non-contrasted CT demonstrating mild dilated ventricles and a cysticercal cyst (arrow) in the anterior portion of the third ventricle.
B. Same lesion that is better seen on contrasted MRI.
C. MRI of different patient showing a cysticercal cyst (arrow) in the lateral ventricle occluding the foramen of Monro.
Fig 2. Intraoperative Endoscopic Images.
A. Cyst being removed from the cerebral aqueduct.
B. Cluster of racemous cysticercous in the interpeduncular fossa.
C. Multiple cyst in the cisterna magna.
Table 1. Treatment guidelines for the diverse forms of neurocysticercosis
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PARENCHYMAL NEUROCYSTICERCOSIS |
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Vesicular cysts |
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Single |
Albendazole 15 mg/kg/day for one week, steroids used only if side effects occur. Alternative: praziquantel 100 mg/kg in 3 divided doses |
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Moderate infections: |
Albendazole 15 mg/kg/day for one week, with simultaneous use of steroids |
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Heavy infections (100 or more cysts) |
Albendazole 15 mg/kg/day for one week with high doses of steroids. |
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Degenerating (‘colloidal’) cysts |
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Single lesions: |
Albendazole 15 mg/kg/day for one week, steroids used only if side effects occur. Alternative: no antiparasitic treatment. |
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Moderate infections: |
Albendazole 15 mg/kg/day for one week with steroids |
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Heavy infections (encephalitis) |
No antiparasitic treatment. High doses of steroids. Osmotic diuretics (mannitol). |
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Calcifications |
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Single or multiple |
No antiparasitic treatment. Steroids rarely needed. |
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EXTRAPARENCHYMAL NEUROCYSTICERCOSIS |
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Subarachnoid neurocysticercosis |
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“Giant” cyst (usually in Sylvian fissure) |
Albendazole 15 mg/kg/day for prolonged periods (one month or longer), with high doses of steroids. Surgical excision as an alternative |
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Basal subarachnoid (racemose) |
Albendazole 15 mg/kg/day for prolonged periods, with high doses of steroids. |
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Ventricular cysts |
Endoscopic aspiration or surgical resection. Use of antiparasitic drugs is controversial. |
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Hydrocephalus |
No antiparasitic treatment. Ventricular shunt. |
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Arachnoiditis, angiitis |
No antiparasitic treatment. High doses of steroids for prolongued periods |
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Ependymitis |
No antiparasitic treatment. Ventricular shunt if indicated. High doses of steroids |
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OTHER FORMS OF NEUROCYSTICERCOSIS |
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Spinal cysts |
Surgical resection. Albendazole may be used. |
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Ocular cysts |
Surgical resection |
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From: Lancet Neurology, 2005.