Neeraj Jain, Vibha Jain, Deepak Seth.
Department of Pediatrics, HIHT jolly Grant, Deharadun, India.
ADDRESS FOR CORRESPONDENCE
Dr Neeraj Jain, Associate Professor of Pediatrics, HIHT Jolly Grant, Deharadun.
Email: neerajjain@vsnl.net | Introduction
Neurocysticercosis is the most common parasitic infection of the central nervous system. It's a more common disease in America and Latin America , Mexico , Africa , Eastern Europe and Asia . It is called Neurocysticercosis as neuro = brain, cysticercus = cyst of cercus (tapeworm) sis = disease. The larvae of T solium (Cysticercus cellulosae) cause neurocysticercosis. The ova of the tapeworm spread via the fecal-oral route. The intermediate host is the pig, which harbors the larvae after eating ova, while the definitive host is the human being. Occasionally the eggs may be present in the food of humans or eggs may auto infect the humans and leads to formation of larva which then migrates in the body and if it spreads to the brain leads to Neurocysticercosis. The larva may also migrate to other parts of the body such as eyes, muscles and forms cysts. Ova are ingested, neurocysticercosis may occur in this normally intermediate host. The ingested ova develop into larvae (cysticerci) and lodge in soft tissues, especially skin, muscle, and brain. Cysticerci are fluid-filled oval cysts, approximately 1-2 cm in diameter, with an internal scolex.
In the central nervous system
Neurologic symptoms arise when the encysted worm dies and leading to an inflammatory response. If the cyst lodges in the ventricular system (especially the fourth ventricle), hydrocephalus can occur. Neurocysticercosis typically is benign, and most lesions resolve spontaneously within 2-3 months. Simple neurocysticercosis occurs in children with only a single exposure to cysts. These children tend to have solitary cysts and fewer complications. Complicated neurocysticercosis occurs in children in endemic areas who are constantly re-exposed to ova.
The most characteristic feature in children is the acute onset of focal seizures. Increased intracranial pressure (due to hydrocephalus, which can occur in 15-25% of cases) causes other common clinical symptoms including headache, nausea, and vomiting.
Less common presentations include hemiparesis, visual changes, progressive obtundation, sciatica (from cauda equina involvement), and sensory disturbances.
Diagnosis
If neurocysticercosis is suspected on the basis of clinical and radiographic evidence, an enzyme-linked immunotransfer blot (EITB) assay of a patient's serum may confirm the diagnosis. Examine stools from patients and their contacts for ova and parasites. Obtain 3 consecutive daily stool specimens. Stool specimens confirm the presence of eggs of cysticerus Enzyme-linked immunosorbent assay (ELISA) can be used on serum and CSF.
Computed tomography scanning
CT scanning shows the cyst and granuloma stages of neurocysticercosis. These cysts can be solitary or multiple and usually are 5-20 mm in diameter.
Magnetic resonance imaging
MRI is the best imaging test overall for the diagnosis. Perform MRI in all patients for whom the clinical history and CT scan findings suggest neurocysticercosis.
Radiography
Soft tissue radiography can be performed to look for extraneural cysts.
Medical care depends on whether the disease is simple or complicated.
Simple neurocysticercosis - can be treated symptomatically and have a favorable prognosis. In the majority of cases, the cyst has died and cysticidal drugs are not necessary. Complicated neurocysticercosis - have a less favorable prognosis because of complications from increased intracranial pressure and difficulty controlling in seizures. Reserve neurosurgical intervention for cases of cysts that have failed to resolve with antihelminthic treatment and are causing severe neurologic sequelae. Resolution of lesions with medical management alone is superior and should be attempted first.
Drugs
Antihelminthics
Use for children with viable or multiple cysts. Use for patients with T solium tapeworms in their stool.
Albendazole-15 mg/kg/d PO divided bid for 30 days with meals; not to exceed 800 mg/d (recent data suggest a 1-wk course is as effective as a 4-wk course in children).
Praziquantel in children > 4 years (Not established in children less 4 years): 50 mg/kg/d PO divided q6-8h for 15 d
Corticosteroids
Useful in cases of increased intracranial pressure as a result of anthelmintic-induced cyst death and resultant inflammation.
Dexamethasone-1-1.5 mg/kg/d IV divided q4-6h for no more than 3-4 d; not to exceed 16 mg/d
Anticonvulsants
Used to control seizures that result from cysts.
Carbamazepine-10-20 mg/kg/d PO divided bid/tid; increase weekly to achieve optimal clinical response, administered tid/qid
Phenytoin-4-8 mg/kg/d PO divided bid/tid | | | | Compliance with Ethical Standards | | Funding None | | | | Conflict of Interest None | | |
| Cite this article as: | | Jain N, Jain V, Seth D. Neurocysticercosis-Some Tips. Pediatr Oncall J. 2007;4. |
|