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      Cysticercal Encephalitis in a Young Female: A Rare Presentation of Neurocysticercosis

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          Abstract

          One of the most frequent parasite infections of the central nervous system is neurocysticercosis. This neurologic condition is caused by Taenia solium ( T. solium) larval infestation. Infected pork intake, poor hygiene practices, water tainted with T. solium, or asymptomatic carriers are the main ways of spread. We describe a case of neurocysticercosis in a young woman who presented with low-grade fever, headache, altered sensorium, and recurrent seizures. Computed tomography of the head revealed an inflammatory granuloma and a ring-increased attenuating lesion in the left temporal region. Additionally, a well-defined rounded discrete lesion was identified in the left parietal region on magnetic resonance imaging of the brain. Even if the symptoms do not initially suggest neurocysticercosis or if the patient lives in a region where the condition is uncommon, our case depicts adding neurocysticercosis to the differential diagnosis for encephalitis.

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          Clinical symptoms, diagnosis, and treatment of neurocysticercosis.

          Hector H. Garcia, Theodore Nash, Oscar Del Brutto (2014)
          The infection of the nervous system by the cystic larvae of Taenia solium (neurocysticercosis) is a frequent cause of seizure disorders. Neurocysticercosis is endemic or presumed to be endemic in many low-income countries. The lifecycle of the worm and the clinical manifestations of neurocysticercosis are well established, and CT and MRI have substantially improved knowledge of the disease course. Improvements in immunodiagnosis have further advanced comprehension of the pathophysiology of this disease. This knowledge has led to individualised treatment approaches that account for the involvement of parenchymal or extraparenchymal spaces, the number and form of parasites, and the extent of degeneration and associated inflammation. Clinical investigations are focused on development of effective treatments and reduction of side-effects induced by treatment, such as seizures, hydrocephalus, infarcts, and neuroinjury.
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            Neurocysticercosis: an update.

            Arturo Carpio (2002)
            Taeniosis and cysticercosis, diseases caused by the parasitic tapeworm Taenia solium, are distributed worldwide where pigs are eaten and sanitation is poor, and also in the more developed countries as a result of increasing migration. Neurocysticercosis is the commonest parasitic disease of the human nervous system. Immunological assays detect positivity for human cysticercosis in 8-12% of people in some endemic regions, which indicates the presence of antibodies against the parasite but not necessarily active or central-nervous-system infection. The only reliable tool for diagnosis of neurocysticercosis is imaging by CT or MRI. The presence of viable cysts with a mural nodule, associated with degenerative cysts and calcifications, is typical. Classification of neurocysticercosis into active, transitional, and inactive forms gives a good clinical-imaging correlation and facilitates medical and surgical treatment. The main clinical manifestations of neurocysticercosis are seizures, headache, and focal neurological deficits, and it can have such sequelae as epilepsy, hydrocephalus, and dementia. Treatment should be individually fitted for each patient, with antiepileptic drugs, analgesics, corticosteroids, or a combination of these. Anthelmintic drugs (praziquantel and albendazole) are used routinely, but so far no controlled clinical trial has established specific indications or definitive doses of treatment. Parenchymal forms of neurocysticercosis have a good prognosis in terms of clinical remission. The most effective approach to taeniosis and cysticercosis is prevention, which should be a primary public-health focus for less developed countries.
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              Diagnosis and treatment of neurocysticercosis.

              William Nash, Marcio Garcia (2011)
              Neurocysticercosis is a parasitic disease caused by the larval (cystic) form of the pork cestode tapeworm, Taenia solium, and is a major cause of acquired seizures and epilepsy worldwide. Development of sensitive and specific diagnostic methods, particularly CT and MRI, has revolutionized our knowledge of the burden of cysticercosis infection and disease, and has led to the development of effective antihelminthic treatments for neurocysticercosis. The importance of calcified granulomas with perilesional edema as foci of seizures and epilepsy in populations where neurocysticercosis is endemic is newly recognized, and indicates that treatment with anti-inflammatory agents could have a role in controlling or preventing epilepsy in these patients. Importantly, neurocysticercosis is one of the few diseases that could potentially be controlled or eliminated-an accomplishment that would prevent millions of cases of epilepsy. This Review examines the rationale for treatment of neurocysticercosis and highlights the essential role of inflammation in the pathogenesis of disease, the exacerbation of symptoms that occurs as a result of antihelminthic treatment, and the limitations of current antihelminthic and anti-inflammatory treatments.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 18 January 2023
                Publication date (Electronic, collection): January 2023
                Volume: 15
                Issue: 1
                Electronic Location Identifier: e33931
                Affiliations
                [1 ] Internal Medicine, Abia State Faculty of Medicine, Abia, NGA
                [2 ] Internal Medicine, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, IND
                [3 ] Otolaryngology, Liaquatian Research Council, Hyderabad, PAK
                [4 ] Pediatrics, Dubai Medical College For Girls, Dubai, ARE
                [5 ] Internal Medicine, All Saints School Of Medicine, St. Roseau, DMA
                [6 ] Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, GBR
                [7 ] College of Medicine, University of Illinois at Chicago, Chicago , USA
                [8 ] Public Health, DC Health, Washington, D.C., USA
                [9 ] Medicine, Government Medical College and Hospital, Chandigarh, IND
                [10 ] Department of Internal Medicine, Lala Lajpat Rai Hospital, Kanpur, IND
                Author notes
                Article
                DOI: 10.7759/cureus.33931
                PMC ID: 9937515
                SO-VID: 90502760-de20-4e87-8cdf-018f9cbaf7fe
                Copyright © Copyright © 2023, Ikeogu et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date accepted : 18 January 2023
                Categories
                Subject: Internal Medicine
                Subject: Neurology
                Subject: Infectious Disease

                Keywords: albendazole,dress syndrome,tumour necrosis factor-alpha (tnfα),taenia solium,neurocysticercosis
                Data availability:
                Keywords: albendazole, dress syndrome, tumour necrosis factor-alpha (tnfα), taenia solium, neurocysticercosis

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