Neurocysticercosis
Key Points
Key Points
- Neurocysticercosis (NCC) is a spectrum of diseases that differ in pathogenesis and optimal management.
- Symptomatic therapya should be the focus of initial and emergency management.
- Anti-parasitic treatment is important, but never an emergency.
- Parenchymal cystic NCC has better outcomes if treated with anti-parasitic drugs along with corticosteroids.
- Subarachnoid NCC does not respond well to single anti-parasitic drugs at doses and durations used for parenchymal NCC. Optimal management may require chronic anti-inflammatory therapy, intensive anti-parasitic therapyb and surgical therapy.c
- Ventricular NCC of the 3rd and lateral ventricles should be treated with minimally invasive surgery when possible, but minimally invasive and open craniotomy are options for 4th ventricular disease. Open craniotomy or cerebrospinal fluid (dCSF) diversion along with anti-parasitic drugs are optimal in select cases. Anti-parasitic therapy should be deferred until after surgical therapy.
- Calcified lesions do not contain viable parasites and should not be treated with anti-parasitic drugs.
b Anti-parasitic therapy for subarachnoid NCC may include prolonged courses of albendazole, high dose albendazole, or combinations of praziquantel and albendazole.
c
Surgical therapy for subarachnoid NCC may include CSF diversion for hydrocephalus or minimally invasive surgical debulking.
d
Adherent cysticerci should be managed with CSF diversion along with anti-parasitic drugs. Open craniotomy is effective for 4th ventricular lesions and the choice of approaches should depend on local surgical expertise.
Definition of Terms
...f TermsHaving trouble viewing table?...
Diagnosis
Diagno...
...tations of NeurocysticercosisHaving troub...
...is a wide range of clinical manifestations o...
...ation should include careful history and...
...mmends serologic testing with enzyme-link...
...ests using crude antigen should be avoided due...
...e Panel recommends both a brain MRI and a non-c...
...ests screening for latent tuberculosis infecti...
...ggests screening or empiric therapy for Stron...
...ends that all patients with NCC und...
...el suggests that the patient with N...
...ommends that patients treated with al...
...ional monitoring is needed for patients receivin...
Treatment
...atment...
...iable Intraparenchymal Neurocysticercosis...
...patients with untreated hydrocephalus or diffu...
...ce of elevated intracranial pressure,...
...nel recommends albendazole monotherapy...
...r combination anti-parasitic therapy....
...mmends albendazole (15 mg/kg/d) co...
...gests retreatment with anti-parasitic the...
...he Panel recommends adjunctive corticostero...
...ends anti-epileptic drugs in all N...
...n patients with few seizures prior to...
...absence of controlled data, the choice of anti-epi...
...l suggests that MRI be repeated at...
...erating Intraparenchymal NCC Includi...
...Panel recommends that patients with...
...recommends anti-epileptic drugs for al...
...the absence of controlled data, the choice of ant...
...ents who have been seizure free for...
...ests albendazole therapy rather tha...
...ommends that patients with SEL treated with...
...e Panel suggests that MRI be repeated at least e...
...suggests brain MRI in patients with s...
Calcified Parenchymal Neurocysticer...
...ecommends symptomatic therapy alone instead o...
...Panel suggests that corticosteroids not...
...ts with refractory epilepsy and CPN, the Panel...
...raventricular Neurocysticercosis...
...recommends MRI with 3D volumetric s...
...sible, the Panel recommends removal...
...in which surgical removal of 4th ven...
...Panel suggests shunt surgery for hydro...
...commends corticosteroids to decrease brain edema i...
...-parasitic drugs with corticosteroid t...
...t neither after successful removal...
Subarachnoid Neurocystice...
...commends that patients with subarachnoid cys...
...he Panel suggests that anti-parasitic therapy be...
...Panel recommends anti-inflammatory the...
...ggests that methotrexate be considered as a st...
...mends that patients with hydrocephalus f...
...sts that some patients may benefit from surgic...
...nal Neurocysticercosis (SN) ...
...Panel recommends corticosteroid treatm...
...anel suggests that both medical (ant...
...ysticercosis (OC) ...
...gests that intra-ocular cysticerci should...
...is no evidence that management of NCC in ch...
...ts that antihelminthic therapy should be...
...1. Classification of Neurocysticercosis Based on...
...ment Recommendations for Different Forms of Parenc...
...parenchymal (VPN) ...
...c therapy Anti-parasitic drugs should be us...
...Viable Cysts Monotherapy with albendaz...
...le CystsAlbendazole (15mg/kg/d in 2...
...nflammatory therapyCorticosteroids should...
...nti-epileptic therapyAnti-epileptic drugs should b...
...Enhancing Lesion due to NCC...
...sitic therapyAlbendazole (15 mg/kg/d in 2...
...atory therapyCorticosteroids should be given con...
...leptic therapyAntiepileptic drugs s...
Calcified Parenchymal Neurocysticercosis...
...itic therapyAnti-parasitic treatment...
...therapyTreatment with anti-epileptic drugs.ᵍ (...
...ti-inflammatory therapyCorticosteroids should...
...ephalitis (with diffuse cerebral edema)...
...i-parasitic drugs; treat diffuse cerebral...
...a Two well-designed randomized trials d...
...mmendations for Therapy of Extraparenchymal...
...raventricular (lateral or 3rd Ventricle)...
...icular (fourth ventricle)...
Either endoscopic or microsurgical cystectomy i...
...sion via a ventriculoperitoneal shuntᶜ ( W ,...
...cular – when surgical removal not feasi...
...arasitic and anti-inflammatory therapy.ᶜ (...
...urgical management of hydrocephalusInitial mana...
...hnoidᵈ (SAN)...
...sitic therapyᵉSubarachnoid cysts do not respond...
...lammatory therapyConcomitant administra...
...pic surgical approach often requires v...
Figure 1. Endemicity of Taenia solium
.... Endemicity of Taenia solium