Cysticercosis in Emergency Medicine Follow-up

  • Author: Ryan Tenzer, MD, FAAEM; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Apr 28, 2009
 

Further Inpatient Care

  • Inpatient treatment is recommended for those receiving antiparasitic therapy since transient worsening of condition may ensue.
  • Neurosurgical intervention often is required in cases of obstructive hydrocephalus, ventricular cysticerci, and in cases refractory to medical treatment.
  • Ophthalmologic surgery is recommended in all cases of ocular cysticercosis since the inflammatory reaction associated with medical therapy may threaten vision.
  • Only standard isolation is required for patients who are hospitalized.
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Further Outpatient Care

  • Prescribe a follow-up CT scan or MRI to assess response to treatment.
  • Long-term anticonvulsant therapy is usually necessary in patients with persistent CNS calcifications. Selected patients who demonstrate radiographic cure and display no seizures over prolonged periods may discontinue anticonvulsant medication.
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Transfer

  • Patients should be transferred to a facility with neurosurgical capability in cases of extraparenchymal disease and in those involving increased ICP, hydrocephalus, mass effect, or herniation.
  • Status epilepticus may require neurological intensive care.
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Deterrence/Prevention

  • Screen family members for parasitic disease. Prophylaxis may be indicated.
  • Educate patients regarding personal hygiene and handling of food.
  • Those traveling to endemic countries should be educated in preventative habits such as proper cooking of meat and avoidance of fecal-oral transmission routes.
  • Endemic areas require inspection for and proper disposal of tainted meat, as well as efforts at proper management of sewage.
  • Mass treatment of large populations has been historically effective in controlling disease.
  • Effective human and/or animal vaccines may be deployed in the near future.
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Complications

Complications of cysticercosis may include the following:

  • Intracranial herniation
  • Stroke
  • Status epilepticus
  • Long-term anticonvulsant use
  • Intraventricular shunt complications
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Prognosis

  • Prognosis for patients with cysticercosis is excellent in almost all cases.
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Patient Education

  • Patients and their families should be familiar with basic first aid for seizures.
  • Education should be provided on use of prescribed medications and the expected course of disease.
  • Provide instruction on indications to seek medical care, including signs of increasing ICP or focal neurologic complaints.
  • Patients prone to seizures should not drive or perform other dangerous activities.
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Contributor Information and Disclosures
Author

Ryan Tenzer, MD, FAAEM  Clinical Assistant Professor of Emergency Medicine, Penn State College of Medicine; Consulting Staff, Department of Emergency Medicine, Lehigh Valley Hospital

Ryan Tenzer, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Howard A Blumstein, MD, FAAEM  Assistant Professor, Surgery; Medical Director, Department of Emergency Medicine, Wake Forest University School of Medicine

Howard A Blumstein, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

William K Chiang, MD  Associate Professor, Department of Emergency Medicine, New York University School of Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center

William K Chiang, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Barry J Sheridan, DO  Chief Warrior in Transition Services, Brooke Army Medical Center

Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP  Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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Nonenhanced CT scan of the brain demonstrates the multiple calcified lesions of inactive parenchymal neurocysticercosis.
Enhanced CT scan of the brain in a patient with neurocysticercosis demonstrates a live cyst with a minimally enhancing wall and an eccentric hyperattenuating scolex.
Nonenhanced (left) and enhanced (right) CT scans of the brain in a patient with neurocysticercosis show multiple ring-enhancing lesions with perifocal edema.
 
 
 
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