Neurocysticercosis Clinical Manifestations and Treatment

Introduction to Neurocysticercosis

• The American College of Physicians and Infectious Diseases Society of America recommend that untreated neurocysticercosis does not cause anaphylaxis, presenting with seizures, increased intracranial pressure, and neurological symptoms related to inflammation around cysts 1, 2, 3

Clinical Manifestations of Untreated Neurocysticercosis

• Seizures are the most common presentation, occurring in the majority of untreated patients (74-100% in follow-up studies), according to the Clinical Microbiology Reviews 1, 4
• Increased intracranial pressure develops from hydrocephalus due to mechanical obstruction of ventricles or inflammatory arachnoiditis, as stated by the Infectious Diseases Society of America 3, 5
• Focal neurological deficits result from mass effect, vasculitis with stroke, or compression of neural structures, as reported by the Journal of Infection 2
• Chronic meningitis can occur with subarachnoid cysts, sometimes presenting with eosinophilic meningitis (20% of cases) but not anaphylaxis, according to the Infectious Diseases Society of America 2

Important Distinction: Hydatid Cysts vs. Neurocysticercosis

• Hydatid cysts can rupture and cause anaphylaxis, particularly liver cysts rupturing into the peritoneal space, as warned by the Journal of Infection 2
• The risks of anaphylaxis and cyst dissemination with hydatid disease are significant enough that treatment should only occur in specialist centers, as recommended by the Infectious Diseases Society of America 2

Pathophysiology of Neurocysticercosis Symptoms

• Symptoms in neurocysticercosis result from local inflammation around degenerating parasites, not systemic allergic reactions, as explained by the Clinical Microbiology Reviews 1, 3
• Residual scarring and calcifications serve as epileptogenic foci, according to the Clinical Microbiology Reviews 1, 4

Clinical Pitfall to Avoid

• The exacerbation of neurological symptoms that occurs 2-5 days after starting antiparasitic treatment should not be confused with anaphylaxis, as stated by the Clinical Microbiology Reviews 1, 6
• This treatment-related inflammation is attributed to local inflammation from dying larvae, not systemic hypersensitivity, and is controlled with corticosteroids (dexamethasone or prednisone), not epinephrine, as recommended by the Infectious Diseases Society of America 1, 6, 7