Cover Image

Neurocysticercosis presenting as Meningoencephalitis

Sourajit Routray, Rajib Ray, Radha Tripathy, Raj Kumar Paul*

Abstract


Human neurocysticercosis, the infection of the nervous system by the larvae of Taenia solium, is a cause of epileptic seizures and other neurologic morbidity worldwide. The disease occurs when humans become intermediate hosts of Taenia solium by ingesting its eggs from contaminated food or, most often, directly from a taenia carrier by the fecal-to-oral route. Cysticerci may be located in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing pathological changes that are responsible for the pleomorphism of neurocysticercosis. The most common clinical manifestation being the seizures (70-90%), but many patients present with focal deficits, intracranial hypertension, or cognitive decline. The accurate diagnosis of neurocysticercosis is possible after interpretation of clinical data together with findings of neuroimaging studies and/ or results of immunological tests. Encephalitis is the inflammation of brain parenchyma presenting as acute febrile illness with altered level of consciousness, confused behavioral abnormality and depressed level of consciousness ranging from mild lethargy to coma and evidence of either focal or diffused neurological sign and symptoms. Parenchymal brain cysticerci in the acute encephalitic phase have been recognized since the first reports of CT in patients with neurocysticercosis. These lesions were described as focal low densities surrounded by oedema and ring-like enhancement after giving contrast medium. The abnormal enhancement of these lesions were related to the breakdown in the blood-brain barrier caused by the inflammatory reaction around dying cysticerci. We report a case of 10-year-old female child presenting with fever, headache and altered sensorium. This case report may help the practitioners to identify this disease with different presentations, some with fatal presentation, so that needful imaging and management would be instituted at the earliest keeping in mind that Anticysticercal drugs are contraindicated in patients with cysticercotic encephalitis because they may exacerbate the inflammatory response within the brain parenchyma.

Keywords


Fever; seizures; altered sensorium; Antiepileptic drugs; steroid; Anticysticercal drug

Full Text:

PDF

References


Del Brutto OH, Sotelo J. Neurocysticercosis: an update. Rev Infect Dis 1988; 10:1075-87.

Karel L Roos, Kenneth L Tyler Ch: 381 Meningitis, Encephalitis, Brain abscess and Empyema. Pg: 3421: Harrison principles of Internal Medicine. 18th edition.

OP Ghai, Vinod K Paul, Arvind Bagga 7th ed: Neurocysticercosis; 546-47.

Del Brutto OH, Santibañez R, Noboa CA, et al., Epilepsy due to neurocysticercosis: analysis of 203 patients. Neurology 42:389–392, 1992.

Medina MT, Rosas E, Rubio-Donnadieu F, et al., Neurocysticercosis as the main cause of late-onset epilepsy in Mexico. Arch Intern Med 150:325– 327, 1990.

Del Brutto OH, Sotelo J. Neurocysticercosis: an update. Rev Infect Dis 1988; 10: 1075-87.

Mervis B, Lotz JW. Computed tomography (CT) in parenchymatous cerebral cysticercosis. Clin Radiol 1980; 31:521-8.

Rajshekhar V. Albendazole therapy for persistent, solitary cysticercus granulomas in patients with seizures. Neurology 1993; 43: 1238-40.

OH Del Brutto, V Rajshekhar, AC White et al., Proposed diagnostic criteria for neurocysticercosis, Neurology, vol. 57, no. 2, pp. 177–183, 2001.

HH Garc´ıa, CAW Evans, TE Nash et al., Current consensus guidelines for treatment of neurocysticercosis, Clinical Microbiology Reviews, vol. 15, no. 4, pp. 747–756, 2002.

Ronald Blanton Ch 295: Cysticercosis: pg: 1235; Nelson Textbook of Pediatrics 19th edition.

TE Nash, G Singh, AC White et al., Treatment of neurocysticercosis: current status and future research needs, Neurology, vol. 67, no. 7, pp. 1120–1127, 2006.




DOI: http://dx.doi.org/10.21746/ijbio.2015.03.006

Refbacks

  • There are currently no refbacks.




Copyright (c) 2015 International Journal of Bioassays

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

International Journal of Bioassays is a member of the Publishers International Linking Association, Inc. (PILA), CROSSREF and CROSSMARK (USA). Digital Object Identifier (DOI) will be assigned to all its published content.