Cysticercosis may involve the brain with a variety of clinical findings based on the number, size, location and host response to the cysts. Sotelo et al developed a classification system for neurocysticercosis. The authors are from the National Institute of Neurology and Neurosurgery in Mexico City.
Major forms:
(1) active (with ongoing infection)
(2) inactive (late sequelae associated with healing)
Active forms: meningeal irritation with increased mononuclear cells and protein in the CSF, and positive CSF serology tests against cysticerci.
(1) arachnoiditis
(2) meningeal irritation with hydrocephalus
Active forms: cyst-related:
(1) location
(1a) parenchymal cysts
(1b) intraventricular cysts
(1c) spinal cysts
(2) host reaction to cysts
(2a) mass effect due to a large cyst or large number of cysts
(2b) vasculitis, with infarction
(2c) brain edema with intracranial hypertension
Inactive forms:
(1) parenchymal calcifications
(2) meningeal fibrosis with hydrocephalus
About half the patients will have combined forms of involvement.
Clinical features:
(1) headache: arachnoiditis, cysts
(2) vertigo: arachnoiditis
(3) vomiting: arachnoiditis
(4) cranial nerve dysfunction: arachnoiditis, chronic hydrocephalus
(5) intracranial hypertension: acute hydrocephalus, chronic hydrocephalus, vasculitis
(6) ataxic gait: acute hydrocephalus
(7) intellectual deterioration: acute hydrocephalus, chronic hydrocephalus
(8) epilepsy: cysts, cyst mass effect, calcifications
(9) unilateral pyramidal signs: vasculitis
(10) psychiatric disturbances: vasculitis
(11) tumorlike signs: cyst mass effect
(12) Parinaud's sign (paralysis of conjugate upward movement of the eyes without paralysis of convergence): chronic hydrocephalus affecting midbrain
Form |
Frequency in 753 Cases (Sotelo et al) |
arachnoiditis |
48.2% |
acute hydrocephalus |
25.7% |
parenchymal cysts |
13.2% |
vasculitis with brain infarction |
2.3% |
mass effect |
1.0% |
intraventricular cysts |
0.7% |
spinal cysts |
0.7% |
parenchymal calcifications |
57.6% |
chronic hydrocephalus |
3.8% |
from Table 1, page 443, Sotelo et al (1985)
Specialty: Infectious Diseases
ICD-10: ,