NEURO-OCULAR CYSTICERCOSIS

By: Dr Rekha Khare

MD.Radiology

Cysticercosis

It is an infection by a parasite Taenia solium, a pork tapeworm forms cysts in different parts of body

Neurocysticercosis

It is parasitic infestation affecting CNS in about 90%

patients with cysticercosis a

common neurological disease

in developing countries

Taenia solium

Two host zoonotic cestode Adult stage lies in small intestine

of human Gravid proglottid at terminal end

of worm full of eggs that are source of infection with larval stage/ cysticercosis

Taenia solium contd…..

Intermediate host is pig harvouring larval cyst anywhere in it’s body

Human gets infected with cyst by accidental ingestion of T. solium eggs by fecal- oral contamination

Clinical presentation

Depends on:

site of lesion

number of lesion

host immune response

Sites for Neurocysticercosis

Meningeal_ basal meninges Parenchymal cerebral cortex

rarely white matter Ventricular_ 50%cases in 4th Spinal cord rare_ blood or

ventriculo-ependymal spread

Neuro-symptoms/signs

Fits/ seizures/ epilepsy-70% Stroke/ TODD paralysis Headache/ Hydrocephalus Neuropsychiatric dysfunction

Ocular cysticercosis

In 5% cases of cysticercosis Cyst may float freely in

anterior/ vitreous chamber Cyst may adhere to retinal &

sub retinal tissue Rarely in eyelid & lacrimal

gland

Ocular- symptoms/signs

Chorioretinitis Vitreous detachment Diminution/ loss of vision patient complaints of painful, swollen

eye with gradual loss of vision

CT findings…..

Depends on stage of evolution of infestation

1.Vesicular stage -viable

Hypo dense nonenhancing lesion

2. Colloid stage- degeneration

Hypo/ isodense lesion with peri.

lesional enhancement/ oedma

CT finding contd…..

3.Nodular Granular stage nodular enhancing lesion

4.Active parenchymal stage

scolex within a cyst may appear

as a hyper dense dot

CT finding contd…..

5.Calcified stage- parasite dies nodular parenchymal calcification

6.Cysticercotic encephalitis diffuse oedma, collapsed ventricle

multiple enhancing parenchymal

lesion

Case no. 1

A lady 30yr was sent in the department of Radiology for CT scan of head

Case 1 contd. History

Severe headache for months Often Fits

Patient was treated in village by some

quacks. NO RESPONSE

Case 1……CECT Head

Next slice…..

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CT scan finding

Most of the brain parenchyma

is riddled with numerous cysts

of varying size(1-10mm), with

dot calcificaion, few nodular

calcification & tiny hypodense

nonenhancing lesion

Diagnosis case no.1

NEURO-CYSTICERCOSIS

brain parenchyma is riddled with

cysts…..characteristic images with

all stages of evolution of parasite

Case no.2

A lady aged 40yr came in the

department of Radiology for

CT scan head

Case no.2 contd.History

Patient complained of-

Painful swollen eye Headache Gradual loss of vision

Clinical examination

On slit lamp exam two VIABLE MOBILE larva are

visualized in anterior chamber

of left eye

Plain CT scan brain……

Next slice…..

Next slice…..

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Ocular region…..

Next slice…..

CT scan finding

Few calcifications in posterior

ocular wall close to optic

nerve head both eye Few dot calcification with

minimal perilesional oedma

Diagnosis case no. 2

NEURO-OCULAR

CYSTICERCOSIS

In correlation with slit lamp

exam. anterior chamber

VIABLE PARASITE SEEN

Diagnosis depends on…

Clinical history Lab test (enzyme linked

immunotransfer blotting) Imaging finding

No diagnostic tests identify all cases of cysticercosis

Neuroimaging

Since the introduction of CT &

later MRI, vast majority of

single enhancing lesion until

then attributed to Tuberculosis

were in fact degenerating

CYSTICERCI