Neurocysticercosis before and after treatment

Case contributed by Dr Carlos Felipe Hurtado Arias

Presentation

Indigent for several years, with dependence on multiple psychoactive substances (marijuana, cocaine) and in a state of malnutrition, who consulted due to clinical symptoms of several months of evolution, consistent with intermittent, progressive headache, until becoming almost constant in the last weeks, that does not yield with common analgesics, and that has been associated with somnolence for 1 week. Upon physical examination, complete dependence is documented for daily basic activities, drowsiness, bradypsychia, bradylalia and a generalized decrease in the strength of the 4 limbs and muscles of the axial region. Denies other symptoms.

Patient Data

Age: 70 years
Gender: Male
MRI

Pretreatment

Multiple lesions are observed that are located mainly in the subarachnoid space of the convexity (cerebral grooves), intraventricular and the basal cisterns, less than 1 centimeter, most with the "point sign". Some cysts are isointense cerebrospinal fluid and adjacent edema sequences with information T2, with the same feature in the FLAIR, while in the T1, some of the cystic lesions are isointense cerebrospinal fluid while others are moderately hyperintense.

In the sequence T2 * GRE, the "point sign" is displayed much better.

In DWI, the liquid is hyperintense, and the "intracystic solid" component has an even greater signal.

The patient was treated for neurocysticercosis, with good response.

MRI

Post-treatment (6 months)

Almost complete resolution of the documented lesions in the previous study. The zones of edema adjacent to the cysts are scarce, very confined to the periphery of the lesion, and significantly smaller than in the initial study.

Case Discussion

This is a patient with risk factors for immunosuppression who consults for neurological symptoms of several months of evolution.

The findings from the beginning were compatible with neurocysticercosis in the vesicular and colloidal phases. This is something very characteristic of this disease, that in the same patient, at the same time, different phases of the disease are found.

The patient was given management for neurocysticercosis, with good evolution. The control resonance at 6 months shows almost complete resolution of the cysts and even a significant decrease in the foci of edema adjacent to the cysts that still persist.

It is evident that after starting the antiparasitic pharmacological treatment, clinical and imaging improvement is dramatic.

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Case information

rID: 68922
Published: 23rd Jun 2019
Last edited: 23rd Jun 2019
Inclusion in quiz mode: Included
Institution: Radiologos Asociados S.A.S - CEDICAF Pereira

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