Further Outpatient Care
See the list below:
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Treat seizures with anticonvulsant medications.
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Follow-up with a neurologist is recommended for patients with numerous lesions or seizures.
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Follow-up with an ophthalmologist is recommended for patients with visual lesions or complications.
Further Inpatient Care
See the list below:
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Monitor patients with cysticercosis for anticonvulsant levels or signs of toxicity.
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Monitor with serial neurologic examinations and initiate corticosteroid therapy if cerebral edema is present.
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Place a ventriculoperitoneal shunt if acute hydrocephalus develops.
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Brain surgery may be recommended for a mass effect, and ocular surgery may be recommended for the removal of cysts.
Inpatient & Outpatient Medications
See the list below:
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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
See the list below:
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Transfer patients if specialized care, such as that provided by a neurosurgeon or ophthalmologist, is needed.
Deterrence/Prevention
See the list below:
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Avoid areas and countries with poor hygiene.
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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.
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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.
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Persons known to have the adult T solium tapeworm should be immediately treated and should exercise care in handwashing to prevent contamination with feces.
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Examine the stool of food handlers who have recently emigrated from countries with endemic disease for T solium eggs and proglottids.
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Raw or undercooked pork should not be eaten, as this may result in infection with the adult tapeworm.
Complications
See the list below:
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Complications of cysticercosis are numerous. They are most severe when they involve the CNS, visual, or cardiac system.
Permanent brain damage, seizures, strokes, hydrocephalus, and vague neurologic symptoms may result.
Blindness often results from ocular cysticercosis, despite antiparasitic and surgical treatment.
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Muscle involvement may result in myositis and myocarditis.
Prognosis
See the list below:
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The prognosis depends on the number and location of lesions, as well as the host response.
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Treatment with antihelminthics may result in radiologic improvement of CNS lesions, but this may or may not result in clinical improvement.
Patient Education
See the list below:
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Improved sanitation and hygiene are essential to the prevention of cysticercosis.
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Use of toilets and proper disposal of human feces that may contain tapeworm eggs may eliminate transmission of infection. Avoid ingestion of unclean water. Proper cooking of pork may result in fewer T solium infections.
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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.
