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.
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.
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.
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.
Complications
Complications of cysticercosis may include the following:
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Intracranial herniation
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Stroke
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Long-term anticonvulsant use
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Intraventricular shunt complications
Prognosis
Prognosis for patients with cysticercosis is excellent in almost all cases.
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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Nonenhanced CT scan of the brain demonstrates the multiple calcified lesions of inactive parenchymal neurocysticercosis.
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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.
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Nonenhanced (left) and enhanced (right) CT scans of the brain in a patient with neurocysticercosis show multiple ring-enhancing lesions with perifocal edema.
