Cysticercosis in Emergency Medicine Treatment & Management

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

Prehospital Care

Patients present with seizure activity, altered mental status, headache, or other neurologic complaints. Prehospital treatment involves standard supportive care including ensuring that adequate airway support, oxygenation, ventilation, and perfusion are maintained. Administration of anticonvulsants may be necessary for prolonged or repeated seizure activity. Empiric naloxone may be given for coma. Hypoglycemia should be corrected.

Next

Emergency Department Care

  • Secure airway, oxygenation, circulation, adequate glucose delivery, and proper monitoring.
  • Administer supportive care for those presenting with seizure activity.
  • Correct metabolic abnormalities.
  • Anticonvulsants are reliably effective in controlling seizures secondary to cysticercosis. Most patients will respond to first-line agents.
  • Steroids, osmotic agents, and/or diuretics are indicated with evidence of increased ICP.
  • Analgesics may be administered for pain control.
  • Initiate diagnostic procedures, including blood work and imaging.
  • Consult appropriate specialists.
Previous
Next

Consultations

  • Consultations may include neurosurgery, neurology, infectious diseases, and ophthalmology. Neurosurgical procedures are frequently required to relieve intracranial pressure. Biopsy or surgical removal of lesions may be necessary.
Previous
Proceed to Medication
 
 
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.

References

  1. Prasad S, MacGregor RR, Tebas P. Management of potential neurocysticercosis in patients with HIV infection. Clin Infect Dis. Feb 15 2006;42(4):e30-4. [Medline].

  2. Ong S, Talan DA, Moran GJ. Neurocysticercosis in radiographically imaged seizure patients in U.S. emergency departments. Emerg Infect Dis. Jun 2002;8(6):608-13. [Medline].

  3. Kramer LD, Locke GE, Byrd SE. Cerebral cysticercosis: documentation of natural history with CT. Radiology. May 1989;171(2):459-62. [Medline].

  4. Das K, Mondal GP, Banerjee M, Mukherjee BB, Singh OP. Role of antiparasitic therapy for seizures and resolution of lesions in neurocysticercosis patients: an 8 year randomised study. J Clin Neurosci. Dec 2007;14(12):1172-7. [Medline].

  5. [Best Evidence] Del Brutto OH, Roos KL, Coffey CS, Garcia HH. Meta-analysis: Cysticidal drugs for neurocysticercosis: albendazole and praziquantel. Ann Intern Med. Jul 4 2006;145(1):43-51. [Medline].

  6. Salinas R, Counsell C, Prasad K. Treating neurocysticercosis medically: a systematic review of randomized, controlled trials. Trop Med Int Health. Nov 1999;4(11):713-8. [Medline].

  7. [Best Evidence] Gongora-Rivera F, Soto-Hernandez JL, Gonzalez Esquivel D, Cook HJ, Marquez-Caraveo C, Hernandez Davila R, et al. Albendazole trial at 15 or 30 mg/kg/day for subarachnoid and intraventricular cysticercosis. Neurology. Feb 14 2006;66(3):436-8. [Medline].

  8. Botero D, Tanowitz HB, Weiss LM, Wittner M. Taeniasis and cysticercosis. Infect Dis Clin North Am. Sep 1993;7(3):683-97. [Medline].

  9. Buitrago M, Edwards B, Rosner F. Neurocysticercosis: Report of fifteen cases. Mt Sinai J Med. Nov 1995;62(6):439-44. [Medline].

  10. [Best Evidence] Carpio A, Kelvin EA, Bagiella E, Leslie D, Leon P, Andrews H. Effects of albendazole treatment on neurocysticercosis: a randomised controlled trial. J Neurol Neurosurg Psychiatry. Sep 2008;79(9):1050-5. [Medline].

  11. Del Brutto OH. Cysticercosis and cerebrovascular disease: a review. J Neurol Neurosurg Psychiatry. Apr 1992;55(4):252-4. [Medline].

  12. Del Brutto OH, Rajshekhar V, White AC. Proposed diagnostic criteria for neurocysticercosis. Neurology. Jul 24 2001;57(2):177-83. [Medline].

  13. Garcia HH, Del Brutto OH. Imaging findings in neurocysticercosis. Acta Trop. Jun 2003;87(1):71-8. [Medline].

  14. Garcia HH, Del Brutto OH. Neurocysticercosis: updated concepts about an old disease. Lancet Neurol. Oct 2005;4(10):653-61. [Medline].

  15. Garcia HH, Pretell EJ, Gilman RH. A trial of antiparasitic treatment to reduce the rate of seizures due to cerebral cysticercosis. N Engl J Med. Jan 15 2004;350(3):249-58. [Medline].

  16. Kalra V, Dua T, Kumar V. Efficacy of albendazole and short-course dexamethasone treatment in children with 1 or 2 ring-enhancing lesions of neurocysticercosis: a randomized controlled trial. J Pediatr. Jul 2003;143(1):111-4. [Medline].

  17. Lamont EB, Sayah A. An occult cause of persistent nausea and vomiting. J Emerg Med. Sep-Oct 1997;15(5):633-5. [Medline].

  18. Loyo-Varela M. Surgical treatment of cerebral cysticercosis. Eur Neurol. 1997;37(2):129-30. [Medline].

  19. Mitchell WG. Pediatric neurocysticercosis in North America. Eur Neurol. 1997;37(2):126-9. [Medline].

  20. Mitchell WG, Crawford TO. Intraparenchymal cerebral cysticercosis in children: diagnosis and treatment. Pediatrics. Jul 1988;82(1):76-82. [Medline].

  21. Richards F Jr, Schantz PM. Laboratory diagnosis of cysticercosis. Clin Lab Med. Dec 1991;11(4):1011-28. [Medline].

  22. Rosenfeld EA, Byrd SE, Shulman ST. Neurocysticercosis among children in Chicago. Clin Infect Dis. Aug 1996;23(2):262-8. [Medline].

  23. Salgado P, Rojas R, Sotelo J. Cysticercosis. Clinical classification based on imaging studies. Arch Intern Med. Sep 22 1997;157(17):1991-7. [Medline].

  24. Sciutto E, Chavarria A, Fragoso G, Fleury A, Larralde C. The immune response in Taenia solium cysticercosis: protection and injury. Parasite Immunol. Dec 2007;29(12):621-36. [Medline].

  25. White AC Jr. Neurocysticercosis: a major cause of neurological disease worldwide. Clin Infect Dis. Feb 1997;24(2):101-13; quiz 114-5. [Medline].

  26. White AC Jr. Neurocysticercosis: updates on epidemiology, pathogenesis, diagnosis, and management. Annu Rev Med. 2000;51:187-206. [Medline].

 
Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.