Neurocysticercosis

Summary: • Neurocysticercosis is caused by pork tapeworm Taenia solium; affected patients will either have traveled to or lived in a country where T. solium is endemic • Eggs from worm or worm's muscular proglottid (reproductive part) are released in the worm's feces, which is consumed by (e.g.) a pig > pig gets taeniasis: worm grows inside pig and cysts form in muscle o Human ingests egg (from salad, fruit, water, etc.) and egg may travel to the head instead of intestine > cyst forms in the brain or eye (neurocysticercosis) > Cystic lesion can be inside the ventricle (intraventricular), in subarachnoid space, or parenchyma • Inflammatory response occurs once worm dies; vesicular (cystic) stage > colloidal phase > involution > calcification (shows up on CT), which can be symptomatic or not o Symptomatic: seizure disorder (parenchymal disease) or papilledema (intraventricular or subarachnoid), mass effect due to increased ICP, 6th nerve palsy, diplopia (cyst in extraocular muscle), vitritis/uveitis/asymptomatic (cyst in eye) o i.e., the alive worm is actually better for you than the dead worm • Diagnosis made by seeing cysticerca in blood or CSF; will see pleocytosis and possibly eosinophils • Treatment: albendazole, praziquantel, sometimes steroids o If worm is alive and encysted in the eye, surgical procedure like vitrectomy may be required to remove the worm →must do an eye exam before starting treatment! o Be prepared for inflammatory consequences if you kill the worm • Takeaways for consumers: undercooked pork is not the only concern o When travelling, it is best to follow CDC guidelines and only eat cooked food so you don't ingest the eggs yourself; avoid salads, peel and wash fruit yourself, boil water before drinkin