Neurocysticercosis

Case contributed by Dr Antonio Rodrigues de Aguiar Neto

Presentation

The patient was presenting focal seizures with secondary generalization and involuntary movements on the left side

Patient Data

Age: 40 years
Gender: Male
MRI

Brain MRI is demonstrating lesions in the broad spectrum of neurocysticercosis, with viable cysts in different stages of the disease. Cysts distribution is near the gray-white matter junction, in the basal ganglia and the corpus callosum.

Most of the lesions are at the vesicular stage, with a well-defined round enhancing structure within the cyst, which represents the scolex. These cysts' contents appear similar to CSF on the T1- and T2-weighted images and do not demonstrate fluid restriction on the diffusion WI. There is no enhancement in most cysts, no surrounding edema, and no mass effect.

Few degenerating cysts are progressing from the vesicular stage to the colloidal vesicular stage, with light ring enhancement, less defined scolex, and minimal surrounding edema.

The giant degenerating cyst located in the right superior frontal gyrus and centrum semiovale is in the colloidal vesicular stage, which is characterized by marked ring enhancement, an intense inflammatory reaction in the adjacent parenchyma, with surrounding edema and mass effect. 

There are also rare small foci of hypointensities on T2 WI in both cerebral hemispheres, without surrounding edema, which represents the nodular calcified stage.

MRI

The patient`s treatment was with antiparasitic,  Albendazole 400mg 12 / 12h. During the patient’s follow-up, he did a new brain MRI with an interval of six months from the first one, which revealed the evolution of the brain lesions. There are cysts in various stages, most of them in the vesicular stage with scolex; some few degenerating cysts in the vesicular colloidal and rare in the granular nodular stages; there are also rare lesions in the nodular calcified stage.

The degenerating cyst located in the right superior frontal gyrus and ipsilateral centrum semiovale, which was giant in the previous exam, showed retraction with reduction of the size and it is now an irregular sphere, with less surrounding edema compared with the previous MRI. This cyst is progressing from the vesicular colloidal stage to the granular nodular stage.

Case Discussion

Neurocysticercosis (NCC) is a parasitic disease of the central nervous system (CNS) in humans 1,2,3, and an important cause of acquired epilepsy in the developing world, especially Latin America, India, Africa, and China 1.

This case presented a definitive diagnosis of the disease based on the presence of one absolute criterion (an imaging exam revealing a cystic lesion with scolex). It also demonstrates typical features of all stages of neurocysticercosis (vesicularcolloidal vesiculargranular nodular, and nodular calcified 3), and characterizes the evolutionary aspects of NCC lesions' appearance over time. 

Case courtesy

  • Erick Cavalcante, MD - PGY-3, Radiology Resident, Department of Radiology
  • Antonio Rodrigues de Aguiar Neto, MD - Radiologist, Department of Radiology
  •  Hospital da Restauração – Recife, PE – Brazil
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Case information

rID: 69852
Published: 26th Jul 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: Real Hospital Português de Pernambuco - Recife, PE - Brazil

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