Cerebral Cysticercosis Presenting With Recurrent Epileptic Seizures

Abstract

Cerebral cysticercosis is the most common parasitic disease of the human nervous system. It is endemic to some tropical countries but has rarely been described in Vietnam. We report three cases of neurocysticercosis in patients from north-west Vietnam presenting with recurrent epileptic seizures. Hypereosinophilia and positive immunoglobulin G (IgG) antibodies to cysticercosis were detected in two patients and three patients, respectively. The brain MRI showed multiple ring-enhancing cerebral lesions with a well-defined border. Scolexes were demonstrated on fluid attenuation inversion recovery (FLAIR) sequence as small images associated with a hyperintense cyst wall. Treatment of cerebral cysticercosis infection with albendazole 15 mg/kg/day x 21 days along with antiepileptic drug therapy usually results in a favorable outcome. These results highlight that cerebral cysticercosis should be suspected in patients from an endemic area who present with headaches and/or epileptic seizures.

Keywords: cerebral cysticercosis; magnetic resonance imaging; seizure.

Figure 1. MRI findings of case 1 (axial T1 weighted images)

The axial T1 weighted image after contrast showed a ring-enhancing cystic lesion with a well-defined border in the right occipital lobe. The diameter of this lesion was 11 mm. A scolex was demonstrated as a small image associated with a hyperintense cyst wall (A). A similar lesion was found in the right frontal lobe with 10 mm in diameter (B) MRI: magnetic resonance imaging

Figure 2. MRI axial T2 weighted image of case 1

The axial T2 weighted image showed a hyperintense, well-defined border cystic lesions in the right frontal lobe with a diameter of 11 mm MRI: magnetic resonance imaging

Figure 3. MRI findings of case 2

The sagittal T1 weighted image after contrast showed well-defined ring-enhancing cystic lesions (5-10 mm) in the cerebral hemisphere (A). The coronal T1 weighted image after contrast showed well-defined ring-enhancing cystic lesions (7-9 mm) in the cerebral hemisphere. Scolexes were demonstrated inside the lesions (B) MRI: magnetic resonance imaging

Figure 4. MRI findings of case 3

The sagittal T1 weighted image after contrast showed well-defined ring-enhancing cystic lesions (5-10 mm) in the right frontal lobe and parietal lobe with the scolex of Taenia solium cysticercosis inside (red arrows). The cystic lesion in the right temporal lobe had perilesional edema (yellow arrow) (A). A similar lesion located in the left parietal lobe was enhanced after contrast with a scolex of Taenia solium cysticercosis inside (red arrow) (B and C) MRI: magnetic resonance imaging