Classification of Sotelo et al for Neurocysticercosis

 

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)