Hydrocephalus and neurocysticercosis: cases illustrative of three distinct mechanisms

Abstract

Background: Cysticercosis is the most frequent parasitic infection of the nervous system. Most lesions are intracranial, and spinal involvement is rare. We describe here in two cases of neurocysticercosis (NCC) in the brain and one in the spinal cord that illustrate three distinct mechanisms leading to symptomatic acute hydrocephalus.

Case report: Hydrocephalus was related to intracranial NCC in two of them. In the first case the hydrocephalus was due to an extensive arachnoiditis to the craniocervical junction, while in the second it was caused by obstruction of Magendie's foramen in the fourth ventricle by the scolex of Taenia solium. For the third patient, hydrocephalus revealed cysticercosis of the cauda equina due to the scolex.

Conclusions: NCC should be considered as a possible diagnosis for patients suffering from hydrocephalus when they originate from or have traveled in endemic areas, MRI of the spine is mandatory to search for intraspinal lesions.

Keywords: brain; cauda equina; hydrocephalus; neurocysticercosis; tropical disease.

Fig. 1

Case 1. A: Brain sagittal T1-weighted MRI sequence showing tetraventricular hydrocephalus due to a thin-walled cystic lesion located in the lower fourth ventricle (black arrow). B: Photograph of the cystic lesion with the scolex of a Taenia solium larva.

Fig. 2

Case 2. A: Sagittal T2-weighted MRI sequence demonstrating hydrocephalus and an inflammatory arachnoiditis involving the posterior fossa and craniocervical junction (arrow). The two cerebellar peduncles are turned upwards. B: Noninjected sagittal brain CT scan showing dilated lateral ventricles.

Fig. 3

Case 3. A: Noninjected axial CT scan showing dilated lateral ventricles with a calcified cyst in the right occipital lobe. B: Sagittal T2-weighted MRI sequence of the lumbar spine demonstrating mass lesion compression of the cauda equina at L5-S1 (black arrow). C: Brain axial MRI T1-weighted sequence showing hydrocephalus and hyperintense calcified cyst (black asterisk).