Neurocysticercosis presenting as Meningoencephalitis

Author(s): 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.

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