Racemose neurocysticercosis

Abstract

Background: Neurocysticercosis (NCC) is an invasive parasitic infection of the central nervous system caused by the larval stage of the tapeworm Taenia solium. The clinical manifestations of NCC depend on the parasitic load and location of infection, as well as the developmental stage of the cysticerci and host immune response, with symptoms ranging from subclinical headaches to seizures, cerebrovascular events, and life-threatening hydrocephalus. Racemose NCC represents a particularly severe variant of extraparenchymal NCC characterized by the presence of multiple confluent cysts within the subarachnoid space and is associated with increased morbidity and mortality, as well as a decreased response to treatment. Albendazole is the preferred drug for the treatment of racemose NCC due to its superior cerebrospinal fluid penetration compared to praziquantel and the ability to be used concomitantly with steroids.

Case description: In this report, we describe a 39-year-old man recently emigrated from Mexico with racemose NCC and hydrocephalus successfully treated with prolonged albendazole treatment, high-dose dexamethasone, and ventriculoperitoneal shunt placement for the relief of obstructive hydrocephalus.

Conclusions: Treatment of racemose NCC represents a significant clinical challenge requiring multimodal intervention to minimize infectious- and treatment-related morbidity. We review the clinical, diagnostic, and therapeutic features relevant to the management of this aggressive form of NCC.

Keywords: Neurocysticercosis; Taenia solium; racemose; treatment.

Figure 1

(a) Axial T2-weighted magnetic resonance imaging demonstrating multiple confluent cystic lesions in the basal cisterns and sylvian fissures. (b) Fluid-attenuated inversion recovery magnetic resonance imaging showing multiple cystic lesions with the largest cyst measuring 21 mm in maximal diameter (dashed arrow) and mild mass effect on the brainstem. (c) Sagittal T1-weighted magnetic resonance imaging postgadolinium administration showing hydrocephalus and cystic lesions in suprasellar, prepontine, and foramen magnum cisterns. (d) Fluid-attenuated inversion recovery magnetic resonance imaging demonstrating multiple cystic lesions within the lateral ventricles bilaterally (arrows) with enlarged ventricles and transependymal flow

Figure 2

(a) Axial T2-weighted magnetic resonance imaging showing cyst resolution within the basal cisterns and sylvian fissures. (b) Fluid-attenuated inversion recovery magnetic resonance imaging showing resolution of the multiple cystic lesions within the lateral ventricles and hydrocephalus