Subarachnoid Cysticercosis, an Unusual Presentation in an Unusual Geographical Context
Luis Jean Pierre Meneses Quiroz1, Faten El Ammar1, Jared Davis1
1Neurology, University of Illinois at Chicago
Background:
Neurocysticercosis (NCC) is a major cause of epilepsy worldwide, especially in underdeveloped countries. However, NCC can be associated with other clinical presentations, especially when it invades atypical CNS areas, including subarachnoid space, brainstem or spine. We present a case of subarachnoid NCC (SNCC) presenting with confusion and hyperproteinorraquia. We review the literature about SNCC, usual clinical and radiographic presentation and current therapeutic efforts to treat this particular presentation
Design/Methods:
Case report and review of the literature
Results:
59 year old man with history of hypertension, Bell's Palsy and remote VP shunt for hydrocephalus of unknown etiology, who presented to the neurology clinic with intermittent confusion and memory deficits. Brain MRI with and without contrast showed multiple cystic lesions in the basal cisterns that are most prominent within the interpeduncular fossa and suprasellar cistern in addition to scattered GRE signal abnormalities consistent with calcified lesions, consistent with neurocysticercosis. CSF studies showed elevated WBCs at 127 (Lymphocytes 59%, Monocytes 36%, Eosinophils 4%, Neutrophils 1%); hyperproteinorraquia with CSF protein 604, CSF culture was negative. NCC IgG antibody was positive in the CSF. Strongyloides and Quantiferon TB tests were negative. After confirmed diagnosis, the patient received a 30 days course of Albendazol without complications
Conclusions:
SNCC has been reported as one of the most lethal presentations of NCC, because of the potential risk for hydrocephalus and ventriculitis, especially during the antiparasitic treatment phase. Moreover, SNCC has been strongly associated with the presence of spinal lesions, which our patient did not have.
Due to the natural cycle of the disease and dynamics of the global population, it is expected that NCC will be more prevalent in the coming years. The identification of this disease is crucial due to the potential for effective therapy with antiparasitic agents such as albendazo