To describe the varied clinical presentations, imaging patterns, and treatment outcomes in seven patients with Neurocysticercosis (NCC).

 NCC is the leading parasitic infection of the central nervous system and a major cause of new-onset seizures in endemic areas. The disease manifests across a wide spectrum depending on cyst stage, host immunity, and lesion burden. Understanding these variations is crucial for accurate diagnosis and optimal management, especially in regions where tuberculoma and glioma mimic NCC radiologically.

Seven patients (aged 31-59 years) presenting with seizures or focal deficits were evaluated using MRI and serology. All received albendazole with corticosteroids and antiepileptics, and outcomes were monitored during admission and follow-up.

Seizures were the predominant presentation in six of seven cases, with one manifesting as focal neurological deficit. MRI revealed lesions in varied evolutionary stages-vesicular, colloid-vesicular, and calcified, affecting both cortical and subcortical regions. Disseminated disease with multiple viable cysts was observed in one patient, while another exhibited recurrent NCC in the prefrontal cortex despite prior treatment. Perilesional edema was common in the colloid stage, correlating with seizure severity. Mild transient hepatotoxicity was noted in one patient receiving albendazole, resolving without intervention. Follow-up imaging demonstrated partial to complete lesion resolution in five cases. Electroencephalographic (EEG) abnormalities, predominantly focal epileptiform discharges, were observed in four patients and corresponded topographically with active lesions on MRI. All patients improved symptomatically, with no mortality reported, though one recurrence occurred three months post-therapy.

This series shows the unpredictable nature of NCC, where individual immune responses and cyst evolution drive highly variable clinical and radiological profiles. Early MRI-based staging enables targeted therapy, and adjunct corticosteroids reduce inflammation-related sequelae. The findings show the value of continued surveillance to prevent recurrence and the need for community-level interventions, such as food hygiene education and deworming programs to reduce disease transmission in endemic regions.