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Neurocysticercosis

Background

Overview

Definition
Neurocysticercosis is a helminthic neurological infection that characteristically manifests as acquired epilepsy.
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Pathophysiology
Neurocysticercosis is caused by the tapeworm Taenia solium, and is acquired via the fecal-oral route, by ingestion of Taenia solium eggs found in the feces of an infected human carrier. Taenia solium is endemic in most low-income countries where pigs are raised. After eggs are ingested, they hatch in the intestine and release oncospheres, which penetrate the intestinal wall. Among other organs, oncospheres travel to the brain, where they develop into cysticerci and lead to neurocystercosis.
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Epidemiology
The incidence of neurocysticercosis in the US is estimated at 0.2-0.6 cases per 100,000 person-years. In the Hispanic population, the incidence is estimated at 1.5-5.8 cases per 100,000 person-years.
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Disease course
Although no pathognomonic clinical picture exists, adult-onset seizures in patients living in endemic regions are highly suggestive of neurocysticercosis. Symptomatic clinical manifestations range from recurrent seizures, focal neurological deficits, increased ICP, cognitive decline, and ocular symptoms.
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Prognosis and risk of recurrence
In the US, the case fatality rate from neurocystercosis is estimated at 2.2%.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of neurocysticercosis are prepared by our editorial team based on guidelines from the Infectious Diseases Society of America (IDSA 2018). ...
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Diagnostic investigations

Screening for latent tuberculosis
As per IDSA 2018 guidelines:
Consider screening for latent tuberculosis infection in patients likely to require prolonged corticosteroids.
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Consider screening or empiric therapy for Strongyloides stercoralis in patients likely to require prolonged corticosteroids.
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  • Initial evaluation

  • Fundoscopy

  • Neuroimaging

  • Serologic testing

Medical management

Monitoring for treatment-related adverse effects: as per IDSA 2018 guidelines, monitor for hepatotoxicity and leukopenia in patients receiving treatment with albendazole for > 14 days.
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  • Antiepileptic drugs

Specific circumstances

Pregnant patients: as per IDSA 2018 guidelines, consider deferring antihelminthic therapy until after pregnancy.
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  • Patients with intraventricular neurocysticercosis in the lateral and third ventricles

  • Pediatric patients

  • Patients with ocular cysticercosis

  • Patients with spinal neurocysticercosis

  • Patients with hydrocephalus or diffuse cerebral edema

  • Patients with single enhancing lesions

  • Patients with viable intraparenchymal neurocysticercosis

  • Patients with subarachnoid neurocysticercosis

  • Patients with calcified parenchymal neurocysticercosis

  • Patients with multiple enhancing lesions

Follow-up and surveillance

Management of persistent cysts: as per IDSA 2018 guidelines, consider retreatment with antiparasitic therapy for parenchymal cystic lesions persisting for 6 months after the end of the initial course of therapy.
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  • Screening of household contacts

  • Imaging follow-up