Diagnostic Considerations
Neurocysticercosis poses a complex diagnostic and treatment dilemma, because its presentation depends on the locations of the lesions, the number of parasites, and the host's immune response, as well as any symptoms.
Other problems to be considered in the evaluation of suspected neurocysticercosis include the following:
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Brain abscess
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Brainstem gliomas
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Cerebral amebiasis
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Central nervous system (CNS) tumors
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Chronic paroxysmal hemicrania
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CNS toxoplasmosis
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CNS cryptococcosis
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Craniopharyngioma
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Mycotic granulomas
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Neurosarcoidosis
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Oligodendroglioma
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Pituitary tumors
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Tuberculous meningitis
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Tuberculosis of the CNS
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Carotid disease and stroke
Stages of T solium involution
While in the nervous system, the T solium parasite goes through different stages of involution, which include the following:
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Vesicular stage: A viable parasite with a mild inflammatory reaction
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Colloidal stage: A parasite with a scolex in the process of degeneration and a severe inflammatory reaction around it
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Granular stage: A parasite with a degenerated scolex and astrocytic gliosis around the cyst
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Calcified stage: A parasite transformed into a calcified nodule with intense gliosis around the cyst.
Differential Diagnoses
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Massive nonencephalitic neurocysticercosis. Photo courtesy of Cysticercosis Working Group in Peru.
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Computed tomographic (CT) scan of the brain in a patient who presented with an episode of generalized tonic-clonic seizure. Note the calcified lesion in the left parieto-occipital region. Subsequent evaluation confirmed the diagnosis of neurocysticercosis.
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T2-weighted magnetic resonance image (MRI) of the brain showing the presence of increased signal as a result of edema in the right frontal region; subsequent studies found a cysticercus in that location.
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Magnetic resonance image (MRI) of the brain in a patient who presented with an episode of generalized tonic-clonic seizure. Note the cyst in the left parieto-occipital region with perilesional edema.