Neurocysticercosis (Taenia solium a pork parasite)
🧠 Neurocysticercosis (NCC) is a CNS manifestation of cysticercosis caused by the pork tapeworm Taenia solium.
It is one of the commonest parasitic CNS infections worldwide and a major cause of epilepsy in endemic regions.
⚠️ Note: Severity of epilepsy does not always correlate with lesion burden.
📖 About
- 🌍 One of the most common parasitic infections globally.
- 💥 Major cause of seizures and epilepsy in patients from endemic regions.
- ⚠️ Antiparasitic treatment may cause initial worsening due to inflammatory reaction.
🔄 Spread
- 🧪 Infection occurs when eggs of T. solium are ingested via faecal-oral contamination.
- 🐖 Cysts from undercooked pork → penetrate gut wall → lodge in tissues (CNS, muscle, eye, skin).
- 🧀 On imaging, cysts may resemble “Swiss cheese”.
📊 Epidemiology
- 🌎 Endemic in South America, Mexico, India, Pakistan, Middle East.
- 🚱 Linked to poor sanitation and free-roaming pigs.
- ✈️ Increasingly seen in developed countries due to migration and travel.
🧬 Aetiology & Pathophysiology
- 🦠 Inflammation around cysts is the main cause of symptoms.
- 👶 Children more likely to present with seizures than adults.
- 🛑 In advanced HIV/immunosuppression → may be asymptomatic due to lack of host response.
🩺 Clinical Features
- ⚡ Seizures (focal or generalized).
- 🤕 Chronic headaches, nausea, vomiting, visual changes.
- 🧍 Muscle involvement → pseudohypertrophy, weakness, calcified nodules.
- 🧠 Focal neurology, stroke-like episodes, altered mental status.
- 📈 Raised ICP, hydrocephalus (especially with ventricular/subarachnoid disease).
- 🔍 Fundoscopy may show larval forms in retina.
- ❌ Typically afebrile (distinguishes from CNS infection like bacterial meningitis).
🔬 Investigations
- 🧪 Immunoblot = serologic test of choice (high sensitivity & specificity).
- 🖥️ CT/MRI: cysts with perilesional oedema; calcifications common. MRI FLAIR or FIESTA sequences improve detection.
- 💉 CSF: often normal; antigen detection via ELISA useful for subarachnoid/ventricular disease.
- 📊 Differential: cystic tumour, TB, abscess.
🖼️ Imaging
💊 Management
- ⚕️ Supportive: ABC, manage seizures (antiepileptics), control raised ICP.
- 💊 Albendazole 15 mg/kg daily × 10 days + Prednisolone 30 mg/day × 14 days → reduces seizures long-term.
- 💊 Praziquantel 50 mg/kg/day × 15 days (alternative).
- ⚠️ Expect transient worsening of seizures at start of therapy.
- 🧠 Steroid-sparing agents (e.g., methotrexate, azathioprine) used if steroids cannot be tapered.
📚 References
