NEUROCYSTICERCOSIS

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NEUROCYSTICERCOSIS A I BHIGJEE SUBDEPT OF
NEUROLOGY THE INKOSI ALBERT LUTHULI CENTRAL
HOSPITAL THE NELSON R MANDELA SCHOOL OF
MEDICINE UNIVERSITY OF KWAZULU/NATAL
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NEUROCYSTICERCOSIS

• EPIDEMIOLOGY
• LIFECYCLE
• NEUROPATHOLOGY
• CLINICAL PRESENTATION
• DIAGNOSIS
• TREATMENT
• PROGNOSIS
• PREVENTION
• CASE STUDY

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NEUROCYSTICERCOSIS

• EPIDEMIOLOGY
• MOST COMMON PARASITIC INFECTION OF THE CNS
• ABOUT 50 MILLION PEOPLE INFECTED WORLDWIDE
• PROBABLY MOST COMMON CAUSE OF EPILEPSY WORLDWIDE
• MOSTLY DEVELOPING COUNTRIES
• LATIN AMERICA
• ASIA
• AFRICA
• ZULUS vs XHOSAS

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NEUROCYSTICERCOSIS

• LIFE CYCLE

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NEUROCYSTICERCOSIS

• NEUROPATHOLOGY
• ASYMPTOMATIC VIABLE CYSTS
• DYING CYSTS
• CALCIFIED CYSTS
• RACEMOSE CYSTS
• MENINGITIS
• VASCULITIS
• HYDROCEPHALUS
• INTRAVENTRICULAR CYSTS
• SPINAL DISEASE
• DISSEMINATED DISEASE

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NEUROCYSTICERCOSIS

• NEUROPATHOLOGY
• STAGES OF NEUROCYSTICERCOSIS LESIONS

Garcia, H. H. et al. N Engl J Med 2004350249-258
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Cyst Circumscribed by a Capsule Composed of Dense
Collagenous Tissue with Chronic Inflammatory
Cells (Arrows) (Hematoxylin and Eosin, x30)
Bromfield, E. B. et al. N Engl J Med
2000343420-427
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NEUROCYSTICERCOSIS

• CLINICAL PRESENTATION
• HEADACHE
• SEIZURES
• STROKES
• DEMENTIA
• PARAPARESIS
• DISSEMINATED CYSTICERCOSIS

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NEUROCYSTICERCOSIS

• DIAGNOSIS
• X-RAYS OF MUSCLES SKULL
• CT SCAN
• MRI
• SEROLOGICAL TESTS
• CSF EXAMINATION

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NEUROCYSTICERCOSIS

• DIAGNOSIS CT SCAN MRI

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NEUROCYSTICERCOSIS

• DIAGNOSIS SEROLOGY CSF
• ELISA IN SERUM CSF
• CSF FINDINGS
• CELLS
• PROTEIN
• GLUCOSE

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NEUROCYSTICERCOSIS

• DIAGNOSIS WESTERN BLOT

Maguire, J. H. et al. N Engl J Med
1993328566-573
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NEUROCYSTICERCOSIS

• TREATMENT
• ALBENDAZOLE 5MG/KG TDS FOR 8-40 DAYS
• PZQ 15-20MG TDS FOR 15 DAYS
• STEROIDS
• ANTICONVULSANTS

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NEUROCYSTICERCOSIS

• PROGNOSIS
• AGE AT PRESENTATION
• PARASITIC LOAD
• SINGLE - DISAPPEARING LESION
• MANY
• SITE TYPE
• INTRAVENTRICULAR
• RACEMOSE
• MENINGITIC

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NEUROCYSTICERCOSIS

• PREVENTION

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NEUROCYSTICERCOSIS

• CASE STUDY DISSEMINATED DISEASE

• IN GREEK MYTHOLOGY WAS ONE OF A GROUP OF GODS
  CALLED THE TITANS.
• THEY FOUGHT AN UNSUCCESSFUL WAR AGAINST ZEUS AND
  OTHER OLYMPIAN GODS.
• ZEUS PUNISHED ATLAS BY FORCING HIM TO STAND AND
  SUPPORT THE SKY ON HIS SHOULDERS FOREVER.

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NEUROCYSTICERCOSIS

• CASE STUDY DISSEMINATED DISEASE
• 24 YEAR OLD MALE FROM LUSIKISIKI
• PRESENTED WITH SEIZURES
• ON EXAMINATION WELL BUILT
• CYSTS IN SUBCUTANEOUS TISSUE
• CYSTS IN MUSCLES
• CYSTS IN BRAIN

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NEUROCYSTICERCOSIS

• CASE STUDY DISSEMINATED DISEASE

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NEUROCYSTICERCOSIS

• CASE STUDY DISSEMINATED DISEASE

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NEUROCYSTICERCOSIS

• CASE STUDY DISSEMINATED DISEASE

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NEUROCYSTICERCOSIS

• CASE STUDY DISSEMINATED DISEASE

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NEUROCYSTICERCOSIS

• CASE STUDY DISSEMINATED DISEASE

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TROPICAL PARASITES THAT MAY CAUSE FOCAL BRAIN
LESIONS
Ropper, A. H. et al. N Engl J Med 2001345126-131