Pathogenesis: Cysticerci may involve the subarachnoid space at the base of the brain. This may be associated with cerebral arteritis or involvement of the ventricular system.
Clinical features:
(1) intracranial hypertension (with papilledema, etc)
(2) meningeal signs
(3) headache
(4) epilepsy
(5) motor deficits
Laboratory features:
(1) inflammation in the CSF (severe if >= 1,000 per µL)
(2) reduced glucose in the CSF
(3) positive ELISA for cysticercal antigen on the CSF
Imaging findings:
(1) parenchymal cysts, some which may be calcified
(2) subarachnoid cysts
(3) basal meningeal enhancement
(4) cerebral infarcts associated with arteritis
(5) hydrocephalus
Differential diagnosis:
(1) superimposed bacterial, tuberculous or fungal (cryptococcal) meningitis, especially if the patient has a shunt
Management:
(1) treatment with corticosteroids
(2) antibiotics for superimposed meningitis
(3) avoidance of albendazole or other anticysticercal drugs in order to prevent worsening of the cerebral inflammation following release of antigenic material
