Further Care
Further outpatient care
Treat seizures with anticonvulsant medications. Follow-up with a neurologist is recommended for patients with numerous lesions or seizures. Follow-up with an ophthalmologist is recommended for patients with visual lesions or complications.
Further inpatient care
Monitor patients with cysticercosis for anticonvulsant levels or signs of toxicity. Monitor with serial neurologic examinations and initiate corticosteroid therapy if cerebral edema is present. Place a ventriculoperitoneal shunt if acute hydrocephalus develops. Brain surgery may be recommended for a mass effect, and ocular surgery may be recommended for the removal of cysts.
Inpatient and outpatient medications
The following medications may be indicated:
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Anticonvulsant medications as indicated
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Corticosteroids for cerebral edema due to inflammation
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Antihelminthic medications if indicated
Transfer
Transfer patients if specialized care, such as that provided by a neurosurgeon or ophthalmologist, is needed.
Deterrence/Prevention
Avoid areas and countries with poor hygiene.
Persons traveling to developing countries with high rates of endemic cysticercosis should avoid ingestion of unboiled or nonpurified water or ice cubes and should also avoid eating uncooked pork or vegetables and fruits that cannot be peeled.
All family members of an index patient with cysticercosis, as well as persons handling their food, should be examined for signs of disease or evidence of adult worm infection.
Persons known to have the adult T solium tapeworm should be immediately treated and should exercise care in handwashing to prevent contamination with feces.
Examine the stool of food handlers who have recently emigrated from countries with endemic disease for T solium eggs and proglottids.
Raw or undercooked pork should not be eaten, as this may result in infection with the adult tapeworm.
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Cysticercosis life cycle. Image courtesy of the Centers for Disease Control and Prevention.
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MRI of 6-year-old boy from Peru with single right frontal cyst (coronal image). Image courtesy of Eric H. Kossoff, MD.
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Axial image MRI of same patient as in Media file 2. Image courtesy of Eric H. Kossoff, MD.
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CT scan of intraparenchymal cysticercosis with lesions in different stages. Lesions that are breaking down demonstrate peripheral enhancement after intravenous contrast injection, whereas lesions without peripheral enhancement are intact. Typical residual calcification from an old focus of infection is observed in the left occipital lobe. Image courtesy of Fred Greensite, MD.
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Racemose (extraparenchymal) cysticercosis (T1-weighted MRI). Note the cyst in the fourth ventricle, causing obstructive hydrocephalus. Image courtesy of Fred Greensite, MD.
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Racemose cysticercosis (T1-weighted MRI). Note cluster of cysts anterior to the pons and inferior to the hypothalamus in a different patient. Image courtesy of Fred Greensite, MD.
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Racemose cysticercosis (same patient as in Media file 6). Note the enhancing margin of the cysts in the suprasellar cistern and in the left sylvian fissure after gadolinium injection (T1-weighted MRI). Image courtesy of Fred Greensite, MD.
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Racemose cysticercosis (same patient as in Media files 6-7). Coronal image (postgadolinium T1-weighted MRI) posterior to the slice in Media file 7. Cysts in this slice (below the hypothalamus) do not have enhancing margins. Also, unlike intraparenchymal lesions, scolexes are typically not identified in the cysts of racemose cysticercosis. Image courtesy of Fred Greensite, MD.
