A Mexican Case of Massive Nonencephalitic Neurocysticercosis

Abstract

Neurocysticercosis is common in Asia, Africa and South America including Mexico. A diagnosis of neurocysticercosis was made neuroradiologically in an 8-year-old Mexican girl, who had suffered from learning difficulties for a year, and subsequently developed headache, vomiting, gait disturbance, visual hallucination, apraxia and euphoric state for 4 months. Plain CT demonstrated numerous cystic lesions with or without scolex in addition to calcified lesions. The lesions were seen throughout the whole brain, although they were relatively scarce in the cerebellum and the lateral ventricular system. Although edema was prominent around the bilateral ventricles, neither ventricular dilatation, midline shift nor inflammatory reaction around the cysts was detected. The patient was treated with albendazole for a month and with steroid for two months. Headache and vomiting disappeared in the first week of treatment but other symptoms persisted, with fluctuation. CT after 2 months of treatment showed dilatations of the third and lateral ventricles. Despite massive infection in the brain, the clinical picture at onset was mild and compatible with nonencephalitic cerebral cysticercosis. The symptoms might be caused by the progressive hydrocephalus due to cerebrospinal fluid blockage, the prognosis of which is predicted to be poor.