Diagram depicting the appearance of the four stages of neurocysticercosis on non-contrast CT (NCCT) and various MRI sequences.
During the vesicular stage, the parasite is alive, and there is no inflammatory reaction. When the parasite dies, the cyst wall breaks down and a brisk inflammatory reaction occurs with enhancement and edema. The cyst fluid gradually thickens, and eventually, diffusion restricts.
Over time, the lesion shrinks, and inflammatory changes reduce, eventually culminating in a calcified focus.
Case Discussion
It is important to note that the four stages of neurocysticercosis are not cleanly defined separate entities but rather represent a continuum, and the changes in each sequence do not line up precisely with these stages (e.g., the cyst fluid in the early colloidal vesicular stage will generally not diffusion restrict). Patients will also often have multiple cysts at multiple different stages at the same time.
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