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| Cysticercosis |
| Organism: Taenia Solium |
| Symptoms |
| Any one or combination of: seizures, focal neurological
deficit, headache, hydrocephalus, arachnoiditis, chronic meningitis, encephalitis. |
| Diagnosis |
 | Imaging study: CT, MRI, showing punctate calcifications or fluid filled
cystic lesions. Edema or enhancement of the cyst suggest active disease. |
| Serum Cysticercosis Antibody: high percentage of false positive for
patients from endemic area (?30%) |
| CSF ELISA for the detection of anticysticercal antibodies is accurate when performed in patients with active meningeal disease.
The test is most often negative in those with inactive
neurocysticercosis or in those with parenchymal cysts. |
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| Treatment |
| Need eye examination prior to treatment |
| Therapy must be individualized.
 | Calcified lesions should only receive symptomatic treatment. |
| Patients with parenchymal or subarachnoid cysts
should be treated with Cysticidal drugs. (see below) |
| Patients with ventricular cysts may also be treated with albendazole; however, endoscopic removal is the current approach to these lesions. |
| Cysticidal drugs may exacerbate the brain edema associated with cysticercotic encephalitis and are contraindicated in this form of the disease. |
| In these cases, dexamethasone (16 mg/day) and mannitol (100 ml every 6 hours) are advised for the management of intracranial hypertension. |
| Corticosteroids are also indicated as the primary form of therapy for patients with cysticercotic angiitis, arachnoiditis, and to prevent secondary reactions related to the use of cysticidal drugs. |
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| Cysticidal drugs: both doses and duration of
therapy are controversial.
| Praziquantel (3 doses of 25 to 30 mg/kg given every 2 hours).
 | Comes in 600 mg. cost $200 for 18 tabs. |
| May cause headache, dizziness and GI
upset. |
| The tablets should be washed down unchewed
with some liquid during meals. Keeping the tablets in the
mouth can reveal a bitter taste which can promote gagging or
vomiting. |
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| Albendazole (15 mg/kg/day for one week)
| Comes in 200 mg tab, given BID. |
| Cost about $60 for 36 tab. |
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| Longer steroid treatment may be needed for
vasculitis, arachnoiditis. |
| Treat seizure with the usual anticonvulsant. |
| Hydrocephalus: VP shunt |
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| Further reading |
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