Images in Clinical Medicine
Neurocysticercosis
N Engl J Med 2004; 350:266January 15, 2004
- Article
A 15-year-old Peruvian girl who lived in the Andes mountains had a three-month history of headache, nausea, vomiting, and visual obscuration and a one-month history of incoherent speech, confusion, and visual and auditory hallucinations. On examination, she had bilateral papilledema, neck stiffness, and psychomotor retardation. Magnetic resonance imaging (MRI) of the brain revealed numerous diffusely distributed, cystic areas, which created a “Swiss cheese” appearance. On the T2-weighted scan (Panel A), the cysts were bright. On the T1-weighted scan (Panel B), numerous cysts were evident in the tongue, and intraventricular cysts (arrow) were also present. The cysts were dark, although after the administration of gadolinium, a few showed ring enhancement (Panel C). The FLAIR (fluid-attenuated inversion recovery) sequence showed an eccentrically positioned, punctate, bright signal within most of the cysts, each representing a scolex (Panel C, inset). A stool examination revealed ova of the pork tapeworm, Taenia solium. Western blot analysis was positive for cysticercosis. The serum white-cell count was normal, and the eosinophil count was 4 percent. The patient was treated for one month with albendazole (15 mg per kilogram of body weight per day) and prednisone (60 mg per day, with tapering of the dose at the end of the month). At a follow-up visit eight months later, the patient's recovery was found to be clinically complete, and MRI of the brain revealed resolution of the cysts.
Howard W. Sander, M.D.
Weill College of Medicine of Cornell University, New York, NY 10022Conrado Castro, M.D.
Instituto Especializado en Ciencias Neurologicas, Lima, Peru- Citing Articles (1)
Citing Articles
1
L.T. Lucato, M.S. Guedes, J.R. Sato, L.A. Bacheschi, L.R. Machado, C.C. Leite. (2007) The Role of Conventional MR Imaging Sequences in the Evaluation of Neurocysticercosis: Impact on Characterization of the Scolex and Lesion Burden. American Journal of Neuroradiology 28:8, 1501-1504
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