Neurocystircosis

Tania solium

Pig tapeworm

Ingesting undercooked pork

Food fertilised with pig manure

Usually resides in muscle, less common brain

South America, Africa, SE asia, PNG

Clinical

Epilepsy is the most common presentation 70%

Headache, dizziness

Stroke

Neuropsychiatric dysfunction

Dx:

CSF mononuclear pleocytosis (sometimes eosinophilia)

- DDx: Angiostrongalis, schistosomiasis

Elevated protein

CSF ELISA Sn 50%, Sp65%

Peripheral blood serology

Imaging CT or MRI

Parenchymal – brain and medulaa

- CSF often inconclusive

- Immunological tests on CSF and serum not good

- Viable larve? (Vesticular stage)

o Hypodense non-enhancing

o MRI Cysts = CSF signal, T2 hyperintensei scolex, no enhancement

- Treat with AB’s and steroids

- Occ surgery for big cyst

- Calcifications = parasite dead

o No role for AB’s

o Treat with AEDs

o

Extra-parenchymal – intraventricular or subarachnoid space

- CSF typically inflammatory

- Complications more common – hydrocephalus, vasculitis, cerebral infarcts

Seizures:

Acute symptomatic in setting of dying cysts and acute inflammatory response

- Low rate of evolution to epilepsy

Unprovoked seizures

- Secondary to calcification focus

Overall people with NC has 2.76x risk of epilepsy

1/3 of cases of epilepsy in endemic area’s are due to NC

No clear correlation between lesion burden and epilepsy severity