Epilepsy Due to Solitary Calcified Cysticercus Granuloma

Abstract

The calcified stage of the neurocysticercosis (NCC) is the common cause of acquired epilepsy in low and middle income countries in people aged > 20 years. Approximately 30% of adult onset seizures and epilepsy are attributable to NCC. In India and some of the Latin American countries, epilepsy due to solitary calcified NCC is the common adult onset epilepsy. The current evidence suggests that the calcified cysticercus granuloma is probably the epileptogenic focus. The mechanisms involved in the epileptogenic process are not well understood; Focal-onset seizures with or without impaired awareness are the common seizure type. Focal-onset seizure can evolve to bilateral tonic-clonic seizure. Seizure outcome with anti-seizure medication, most often with monotherapy, is very good. The seizure disorders associated with various stages of NCC can be preventable.

Keywords: anti-seizure medication; convulsive status epilepticus; focal-onset seizure; neurocysticercosis; solitary calcified cysticercus granulaoma; solitary calcified neurocysticercosis.

Figure 1

(A) Non-contrast CT scan showing a solitary hyperdense calcific lesion in the right frontal lobe in an adult woman with left focal-onset impaired awareness seizures; (B) Non-contrast CT scan showing a calcific lesion in the left frontal lobe with perilesional gliosis in a girl with anti-seizure medication resistant epilepsy.

Figure 2

Non-contrast CT scan in an adult showing a round calcific lesion in the left frontal lobe with area of hypodensity anterior to the lesion, he had a recent history of seizures.

Figure 3

FLAIR Hypointense focus in the right frontal lobe surrounded by a rim of hyperintensity, which is in turn surrounded by perilesional edema. Post contrast study shows nearly solid appearing enhancement of the lesion (A–C).

Figure 4

Non-contrast MRI scan showing a hypointense lesion on T2 (A) and fluid attenuated inversion recovery (B) images in the right frontal lobe laterally with the surrounding areas showing volume loss and T2 and FLAIR hyperintensity representing gliotic changes.