Sanjeeb Kumar Sarma (Down Town Hospital/ Guwahati/ India)  

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6 Years  

Female  

Head-Brain and brain nerves  

inflammatory or infectious  

A 6 year old female child presented with history of three episodes of seizure in last fifteen days. No complains other than that.  

Neurocysticercosis (NCC) is caused by larval form of pork intestinal tapeworm Taenia Solium. Humans are definitive host. NCC is the most common parasitic infection worldwide. It is endemic in Asia, Africa, Eastern Europe and Latin America. The general autopsy incidence of cysticercosis in those countries is approximately 4%.
CNS infections occur in 60-90% cases of patients with cysticercosis. Brain parenchyma is the most commonly affected site. Corticomedullary junction is the primary location. Intraventricular cysticercosis cysts are seen in 20-50% cases with 4th ventricle a common site. Only 10% cases of NCC have isolated subarachnoid disease.
Morbidity with NCC results from dead larvae that typically incite an intense host inflammatory response. NCC has broad spectrum clinical manifestations. Epilepsy is the most frequent symptom and is seen in 50-70% cases.
Pathologically parenchymal cysticercosis has been classified into four stages: vesicular, vesicular colloidal, granular nodular and nodular calcified. Patients may have multiple lesions at different stages.
Vesicular stage: During this stage cysticercus consists of thin capsule that surrounds a viable larva and its fluid containing bladder. There is no inflammatory reaction seen in this stage. Edema and contrast enhancements are rare in this stage.
Colloidal vesicular stage: In this stage larva dies and degenerate. Cystic fluid becomes turbid and the cyst shrinks as its capsule thickens. Inflammatory response present and edema is seen. Ring like contrast enhancement is seen. MRI scans shows hyperintense cystic fluid compared to CSF at this stage.
Granular nodular: At this stage cyst retracts, its capsules thickens and scolex calcifies which is seen well in CT scan. Perilesional edema is still present and ring enhancement is seen. At this stage the cyst is typically isointense on T1WI and hypointense on T2WI. The present case is in this stage.
Nodular calcified: At this stage size retracts and totally calcified. CT scan shows calcification better than MR.
The patient recovers completely with medication.  

<- view MRI 1

MRI 1: Axial T1WI showing only the subtle hypointensity in the right high parietal region.





<- view MRI 2

MRI 2: Axial T2WI showing 4 mm sized hypointense lesion with surrounding edema in right high parietal region.





<- view MRI 3

MRI 3: Coronal T2WI showing the same lesion in right high parietal region.





<- view MRI 4

MRI 4: Axial FLAIR image showing features similar to T2WI





<- view MRI 5

MRI 5: Axial contrast scan showing ring like enhancement with central hypointensity.





<- view MRI 6

MRI 6: Coronal contrast scan showing the same lesion





<- view MRI 7

MRI 7: Sagittal contrast scan showing the same lesion in the corticomedullary junction of right high parietal region.



 

Imaging including endoscopy  

Developmental or post traumatic cyst, Cystic tumor etc.  

Prognosis is excellent. Complete cure is seen with the use of antihelminth drugs  

Plain CT scan done previously could not pick up the lesion. Follow up scan after treatment reveals absolutely normal MR scan.  

N/A  

1. Medline:
Christopher M. DeGiorgio, Marco T. Medina, Reyna Durón et al
Neurocysticercosis
Epilepsy Curr. 2004 May; 4(3): 107–111.

Diagnostic Neuroradiology by Anne G. Osborn (Mosby)- chapter 16- Infection of the Brain and its linings P- 709-712.  

Neurocysticercosis, taenia solium, larva, brain, human, definitive host, child, childhood, pediatric radiology  

Sanjeeb Kumar. Neurocysticercosis. PedRad [serial online] vol 9, no. 4.
URL: www.PedRad.info/?search=20090428145402