Images in Clinical Tropical Medicine Massive Neurocysticercosis: Encephalitic versus Non-encephalitic

Most patients with neurocysticercosis have few intracranial lesions. However, a small subset show development of mas-sive infections that may be divided into encephalitic and non-encephalitic. Proper differentiation of both forms is important because they have different pathogenetic mechanisms and require different therapeutic approaches. The encephalitic form often occurs in children and young women who have not had contact with the parasite until they are infected with a heavy load of Taenia solium eggs.1 In these cases, the host’s immune system actively reacts against the parasites. The clinical picture is that of acute encephalitis, and neuroimaging shows multiple degenerating cysticerci and marked brain swelling (Figure 1). Cysticidal drugs are not needed because most parasites will die spontaneously. More-over, use of these drugs can exacerbate the inflammator