Further Outpatient Care
See the list below:
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Children who have single nonviable lesions and do not require antihelminthic treatment can be managed safely on an outpatient basis. Most children can be managed as outpatients, especially in the United States where cases are often simple neurocysticercosis.
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Arrange neurologic follow-up care to manage seizures and any sequelae.
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Perform a follow-up MRI in 3-6 months or sooner if symptoms worsen or recur.
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If a child who was admitted for antihelminthic treatment is doing well after 72 hours and follow-up care is assured, the child can be discharged to finish therapy at home.
Further Inpatient Care
See the list below:
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Indications for admission in patients with neurocysticercosis include the following:
Children who need antihelminthic therapy for active or multiple cysts (hospitalize for first 72 h of therapy)
Signs of increased intracranial pressure or apparent need for corticosteroid treatment
Recalcitrant seizures
Hydrocephalus, possibly requiring an intraventricular shunt
Inpatient & Outpatient Medications
See the list below:
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Anticonvulsants, with carbamazepine and phenytoin as first-choice treatments
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Antihelminthics
Antihelminthic medication is controversial. Reserve such treatment for certain cases.
When antihelminthics are used, albendazole is preferable to praziquantel.
Transfer
See the list below:
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Arrange transfer if the facility is unable to provide neurologic or neurosurgical care deemed necessary.
Deterrence/Prevention
See the list below:
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Prevention of exposure to infected ova in the home and community is the most effective preventative measure.
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Examine stools from contacts using 3 consecutive daily specimens. If positive, contacts should receive single doses of praziquantel (10 mg/kg) or albendazole (400 mg).
Complications
See the list below:
Prognosis
See the list below:
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In cases with single lesions, prognosis is excellent. In those with multiple lesions, especially extraparenchymal, prognosis can be poor.
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Treatment with antihelminthics results in complete resolution or significant regression in 80-90% of patients. Most children with calcified single lesions that do not require antihelminthic treatment have spontaneous resolution in 2-9 months, usually within 3 months.
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Usually, seizures are easy to control, and most children can be weaned from their anticonvulsants within 1-2 years. Most children remain free of seizures.
Patient Education
See the list below:
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Educate patients and their families regarding prevention.
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Emphasize improvement in sanitation, separation of pigs from humans, and food preparation hygiene in endemic areas.
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For excellent patient education resources, please see eMedicineHealth's Infections Center.
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Case 1: Coronal image MRI of a 6-year-old boy from Peru with single right frontal cyst.
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Case 1: Axial image MRI of a 6-year-old boy from Peru with single right frontal cyst.
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Case 2: MRI of a 40-year-old patient with a single parietal calcified cyst.
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Case 2: CT scan of a 40-year-old patient with a single parietal calcified cyst.
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Case 3: MRI of a 47-year-old man with 2 right parietal cysts, one with edema.
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Case 3: MRI of a 47-year-old man with 2 right parietal cysts, one with edema, after the larger cyst had involuted.
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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.
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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.
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MRI of multiple cysts. Image courtesy of the Centers for Disease Control and Prevention.
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MRI of an 87-year-old patient from Europe with bitemporal lesions found incidentally. Image courtesy of Jon Poling, MD.
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Two parietal lesions observed on autopsy specimen.
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MRI of a 40-year-old woman with severe epilepsy and a left temporal single cyst.
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MRI of a 21-year-old woman with left temporal lobe epilepsy and a single cyst.
