Disseminated cysticercosis. New observations, including CT scan findings and experience with treatment by praziquantel

Abstract

Although the symptom complex of disseminated cysticercosis has been well recognized for over half a century, it is not clearly included in recent disease classifications. Three such patients are described whose main features were uncontrolled seizures, progressive dementia, behaviour disorder, muscular pseudohypertrophy, and a relative paucity of localizing neurological signs or signs of raised intracranial pressure. Radiographic calcification in muscles was not seen. A CT scan of the brain showed numerous small discrete lesions. Their attenuation density values were appreciably less than that of calcium and they enhanced slightly with contrast. Magnification revealed that these were scolices within cysticerci. There was no enhancement of the cyst wall and no pericystic oedema. CT scan of muscles showed similar cysticerci producing a 'honeycomb' appearance. This is the first CT demonstration of widely disseminated living cysticerci in brain and muscles. It was confirmed histologically. In the absence of palpable cysticerci, the clinical diagnosis can be missed, although no other disease in its full form presents in this manner. The symptoms are mainly caused by the space-occupying effect of the large number of cysticerci rather than by adjacent tissue swelling such as is seen in the presence of dying parasites. Praziquantel was ineffective and hazardous, causing some known and some previously unreported responses and reactions. All 3 patients died.