Pediatric Neurocysticercosis Clinical Presentation

Updated: Dec 15, 2020
  • Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: Russell W Steele, MD  more...
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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.