-Caused by the larval stage of the pork tapeworm (Taenia Solium)
-Humans get cysticercosis by drinking/eating water/food contaminated by tapeworm eggs (eg: infected pork)
-See life cycle below
–Seizures/headache-Most common cause of adult onset seizures in many countries (70 % of patients)-esp. Latin America, India, Africa, and China
-Can be YEARS after infection. Most never cause symptoms and identified incidentally
-Increased ICP- HYDROCEPHALUS, headache, nausea, vomiting, AMS
-Intraventricular cysts can cause obstructive hydrocephalus (nausea/vomiting/headache), subarachnoid cysts, spinal (<1%), ocular, extra-neural (subQ/intramuscular)
How do you make the diagnosis?
-Stool O&P usually negative as chronic infection
-Peripheral eosinophilia is NOT commonly seen
-If you have a patient from an endemic area with seizure and enhancing lesion on MRI-very likely to be Taenia Solium.
-See criteria below as definitive diagnosis requires at least one absolute criterion or two major plus one minor and one epidemiologic criterion
–Note that identification of the Scolex (anterior end with hooks) in cystic lesion is pathognomonic.
-Serology with EITB (enzyme linked immunoelectrotransfer blot)antibody to T.solium, 83-100 % sensitive, 100 % specific but lab dependent)-takes a while to come back
-A detailed eye exam should be done to rule out ocular cysticercosis
-Brain biopsy rarely done as can be diagnosed by above
Differential Diagnosis (not complete) but do not miss other infectious causes!
–Seizure control (controversial but esp. if multiple lesions, parenchymal involvement, or presenting with seizure)
-Treatment of increased ICP
–Antiparasitic therapy (Albendazole + Praziquantel with better efficacy, always given with or after anti-inflammatory therapy (steroids) due to inflammation with dying cysts. Can RECUR after treatment so needs to be tailored to imaging and symptoms.
-Surgical management if ocular or spinal lesions