History
Several recent publications have reviewed the clinical features of neurocysticercosis. [14, 15, 16, 17, 18] The most characteristic feature in children is the acute onset of focal seizures.
Approximately 65-80% of children diagnosed with neurocysticercosis present with seizures, most often focal in nature. Often, these children are brought to medical attention within 2 days of their initial seizure. In many countries where T solium is endemic, cysticercosis is the major cause of epilepsy. Researchers in rural India reported that 43 of 79 children with first-onset seizure (54.4%) received a diagnosis of neurocysticercosis on the basis of MRI findings. [19]
Increased intracranial pressure (due to hydrocephalus, which can occur in 15-25% of cases) causes other common clinical symptoms, including headache, nausea, and vomiting.
Less common presentations include hemiparesis, visual changes, progressive obtundation, sciatica (from cauda equina involvement), and sensory disturbances.
In a 1996 study by Rosenfeld et al of 753 children in Chicago, none presented with fever. [20]
Risk factors include the following:
-
Children who present with neurocysticercosis frequently have emigrated from an endemic area or are children of emigrants from such an area. In the past, many children were exposed to infection through Hispanic food handlers, but this occurrence is less common now.
-
Neurocysticercosis is endemic in certain communities because of poor sanitation, use of sewage for fertilizer, and lack of controlled pens for pigs.
-
If neurocysticercosis is a possible diagnosis in a child without such risk factors, question the family as to household contacts who have traveled to an endemic area. Remember that infection can precede symptoms by as much as 5 years.
Physical Examination
Most children with neurocysticercosis have normal findings on physical and neurologic examinations. Some patients may present with hemiparesis due to either a cyst or Todd paralysis after a focal seizure. Rarely, children may present with papilledema, hemiparesis, sensory disturbances, or palpable subdermal cysts.
-
Case 1: Coronal image MRI of a 6-year-old boy from Peru with single right frontal cyst.
-
Case 1: Axial image MRI of a 6-year-old boy from Peru with single right frontal cyst.
-
Case 2: MRI of a 40-year-old patient with a single parietal calcified cyst.
-
Case 2: CT scan of a 40-year-old patient with a single parietal calcified cyst.
-
Case 3: MRI of a 47-year-old man with 2 right parietal cysts, one with edema.
-
Case 3: MRI of a 47-year-old man with 2 right parietal cysts, one with edema, after the larger cyst had involuted.
-
Case 4: CT scan of 28-year-old woman with occipital headaches and diplopia; imaging reveals a superior cerebellar cyst, mild ventricular dilatation, and old calcifications in the right insular region. Image courtesy of Gholam Motamedi, MD.
-
Case 4: MRI of 28-year-old woman with occipital headaches and diplopia; MRI discerns prepontine and suprasellar lesions, as well as the superior cerebellar cyst. Image courtesy of Gholam Motamedi, MD.
-
MRI of multiple cysts. Image courtesy of the Centers for Disease Control and Prevention.
-
MRI of an 87-year-old patient from Europe with bitemporal lesions found incidentally. Image courtesy of Jon Poling, MD.
-
Two parietal lesions observed on autopsy specimen.
-
MRI of a 40-year-old woman with severe epilepsy and a left temporal single cyst.
-
MRI of a 21-year-old woman with left temporal lobe epilepsy and a single cyst.
