Makindo Medical Notes

🧠 Neurocysticercosis (NCC) is a CNS manifestation of cysticercosis caused by the pork tapeworm Taenia solium. It is one of the commonest parasitic CNS infections worldwide and a major cause of epilepsy in endemic regions. ⚠️ Note: Severity of epilepsy does not always correlate with lesion burden.

📖 About

• 🌍 One of the most common parasitic infections globally.
• 💥 Major cause of seizures and epilepsy in patients from endemic regions.
• ⚠️ Antiparasitic treatment may cause initial worsening due to inflammatory reaction.

🔄 Spread

• 🧪 Infection occurs when eggs of T. solium are ingested via faecal-oral contamination.
• 🐖 Cysts from undercooked pork → penetrate gut wall → lodge in tissues (CNS, muscle, eye, skin).
• 🧀 On imaging, cysts may resemble “Swiss cheese”.

📊 Epidemiology

• 🌎 Endemic in South America, Mexico, India, Pakistan, Middle East.
• 🚱 Linked to poor sanitation and free-roaming pigs.
• ✈️ Increasingly seen in developed countries due to migration and travel.

🧬 Aetiology & Pathophysiology

• 🦠 Inflammation around cysts is the main cause of symptoms.
• 👶 Children more likely to present with seizures than adults.
• 🛑 In advanced HIV/immunosuppression → may be asymptomatic due to lack of host response.

🩺 Clinical Features

• ⚡ Seizures (focal or generalized).
• 🤕 Chronic headaches, nausea, vomiting, visual changes.
• 🧍 Muscle involvement → pseudohypertrophy, weakness, calcified nodules.
• 🧠 Focal neurology, stroke-like episodes, altered mental status.
• 📈 Raised ICP, hydrocephalus (especially with ventricular/subarachnoid disease).
• 🔍 Fundoscopy may show larval forms in retina.
• ❌ Typically afebrile (distinguishes from CNS infection like bacterial meningitis).

🔬 Investigations

• 🧪 Immunoblot = serologic test of choice (high sensitivity & specificity).
• 🖥️ CT/MRI: cysts with perilesional oedema; calcifications common. MRI FLAIR or FIESTA sequences improve detection.
• 💉 CSF: often normal; antigen detection via ELISA useful for subarachnoid/ventricular disease.
• 📊 Differential: cystic tumour, TB, abscess.

🖼️ Imaging

💊 Management

• ⚕️ Supportive: ABC, manage seizures (antiepileptics), control raised ICP.
• 💊 Albendazole 15 mg/kg daily × 10 days + Prednisolone 30 mg/day × 14 days → reduces seizures long-term.
• 💊 Praziquantel 50 mg/kg/day × 15 days (alternative).
• ⚠️ Expect transient worsening of seizures at start of therapy.
• 🧠 Steroid-sparing agents (e.g., methotrexate, azathioprine) used if steroids cannot be tapered.

📚 References

• Neurocysticercosis – Neurol Clin Pract, 2013
• Stanford: Taenia solium
• target="_blank">Neurocysticercosis Image