Pediatric Neurocysticercosis Clinical Presentation

Updated: Mar 03, 2015
  • Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: Russell W Steele, MD  more...
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Presentation

History

Several recent publications have reviewed the clinical features of neurocysticercosis. [12, 13, 14, 15, 16] 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.

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. [17]

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.

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Physical

See the list below:

  • 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.

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Causes

See the list below:

  • Larvae (cysticercus) of the tapeworm T solium cause neurocysticercosis. Larvae are acquired by ingestion of T solium ova, found in the feces of humans infected with the pork tapeworm.

  • The disease is most common in the developing world, especially in environments where sanitation is poor. Such environments exist in rural areas of Latin America, Asia, Africa, Spain, and Eastern Europe.

  • Since the 1980s, this disease has been recognized more commonly in the United States, frequently in the states of California and Texas and in the city of Chicago, where Hispanics make up a large proportion of the community. The emergence of CT scanning and MRI studies as diagnostic tools also probably accounts for the increased detection since the 1980s.

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