An Unusual Presentation of Neurocysticercosis: A Space-Occupying Lesion in the Fourth Ventricle Associated with Progressive Cognitive Decline

Carolin Kurz Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Germany; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; University Medical Center, Hamburg-Eppendorf, Germany; Division of Neuropathology, Institute of Pathology, Technical University Munich, Germany; Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Germany

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Veronika Schmidt Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Germany; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; University Medical Center, Hamburg-Eppendorf, Germany; Division of Neuropathology, Institute of Pathology, Technical University Munich, Germany; Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Germany

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Holger Poppert Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Germany; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; University Medical Center, Hamburg-Eppendorf, Germany; Division of Neuropathology, Institute of Pathology, Technical University Munich, Germany; Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Germany

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Patricia Wilkins Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Germany; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; University Medical Center, Hamburg-Eppendorf, Germany; Division of Neuropathology, Institute of Pathology, Technical University Munich, Germany; Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Germany

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John Noh Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Germany; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; University Medical Center, Hamburg-Eppendorf, Germany; Division of Neuropathology, Institute of Pathology, Technical University Munich, Germany; Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Germany

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Sven Poppert Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Germany; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; University Medical Center, Hamburg-Eppendorf, Germany; Division of Neuropathology, Institute of Pathology, Technical University Munich, Germany; Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Germany

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Jürgen Schlegel Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Germany; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; University Medical Center, Hamburg-Eppendorf, Germany; Division of Neuropathology, Institute of Pathology, Technical University Munich, Germany; Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Germany

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Claire Delbridge Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Germany; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; University Medical Center, Hamburg-Eppendorf, Germany; Division of Neuropathology, Institute of Pathology, Technical University Munich, Germany; Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Germany

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Clarissa Prazeres da Costa Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Germany; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; University Medical Center, Hamburg-Eppendorf, Germany; Division of Neuropathology, Institute of Pathology, Technical University Munich, Germany; Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Germany

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Andrea S. Winkler Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Germany; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; University Medical Center, Hamburg-Eppendorf, Germany; Division of Neuropathology, Institute of Pathology, Technical University Munich, Germany; Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Germany

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DOI:
https://doi.org/10.4269/ajtmh.15-0099
Volume/Issue:
Volume 94: Issue 1
Page(s):
172–175
Restricted access
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We communicate a case of a middle-aged Brazilian patient with an unusual presentation of fourth ventricular neurocysticercosis: occurrence of two intraventricular cysts at different locations in the brain within 2 years and cognitive decline as the only neurological symptom. Neurocysticercosis was confirmed by magnetic resonance imaging, serology, histology, and genetic analysis. Neurocysticercosis should be considered as a differential diagnosis in cases with atypical neurologic or psychiatric symptoms, atypical neuroimaging and travel history. Especially, fourth ventricular cysts carry the risk of obstructive hydrocephalus and brainstem compression and therefore should be extirpated completely. If complete removal of the cystic structures cannot be proven in cases with surgically treated neurocysticercosis, anthelminthic therapy and thorough follow-up examinations should be conducted.

Author Notes

* Address correspondence to Carolin Kurz, Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675 Munich, Germany. E-mail: kurz@lrz.tum.de

Authors' addresses: Carolin Kurz, Veronika Schmidt, Holger Poppert, and Andrea S. Winkler, Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Germany, E-mails: kurz@lrz.tum.de, veronika.schmidt@tum.de, poppert@neurovasc.de, and andrea.winkler@tum.de. Patricia Wilkins and John Noh, Division of Parasitic Diseases and Malaria, Center for Disease Control and Prevention, Atlanta, E-mails: pwilkins@cdc.gov and jnoh@cdc.gov. Sven Poppert, University Medical Center, Hamburg-Eppendorf, Germany, E-mail: sven@poppert.eu. Jürgen Schlegel, Claire Delbridge, Division of Neuropathology, Institute of Pathology, Technical University Munich, Germany, E-mails: juergen.schlegel@lrz.tu-muenchen.de, c.delbridge@tum.de. Clarissa Prazeres da Costa, Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Germany, E-mail: clarissa.dacosta@tum.de.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2016
Received:
03 Feb 2015
|
Accepted:
09 Oct 2015
|
Published Online:
06 Jan 2016
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
  • 1.

    Levine MZ, Calderon JC, Wilkins PP, Lane WS, Asara JM, Hancock K, Gonzalez AE, Garcia HH, Gilman RH, Tsang VC, 2004. Characterization, cloning, and expression of two diagnostic antigens for Taenia solium tapeworm infection. J Parasitol 90: 631–638.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Winkler AS, Blocher J, Auer H, Gotwald T, Matuja W, Schmutzhard E, 2009. Epilepsy and neurocysticercosis in rural Tanzania—an imaging study. Epilepsia 50: 987–993.

  • 3.

    Winkler AS, 2012. Neurocysticercosis in sub-Saharan Africa: a review of prevalence, clinical characteristics, diagnosis, and management. Pathog Glob Health 106: 261–274.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Nash TE, Garcia HH, 2011. Diagnosis and treatment of neurocysticercosis. Nat Rev Neurol 7: 584–594.

  • 5.

    Takayanagui OM, Odashima NS, 2006. Clinical aspects of neurocysticercosis. Parasitol Int 55 (Suppl): S111–S115.

  • 6.

    Del Brutto OH, 2012. Neurocysticercosis in western Europe: a re-emerging disease? Acta Neurol Belg 112: 335–343.

  • 7.

    Fleury A, Escobar A, Fragoso G, Sciutto E, Larralde C, 2010. Clinical heterogeneity of human neurocysticercosis results from complex interactions among parasite, host and environmental factors. Trans R Soc Trop Med Hyg 104: 243–250.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Takayanagui OM, Odashima NS, Bonato PS, Lima JE, Lanchote VL, 2011. Medical management of neurocysticercosis. Expert Opin Pharmacother 12: 2845–2856.

  • 9.

    Winkler AS, Richter H, 2015. Landscape Analysis: Management of Neurocysticercosis with Emphasis on Low- and Middle-Income Countries. Geneva, Switzerland: World Health Organization. Available at: http://apps.who.int/iris/bitstream/10665/152896/1/WHO_HTM_NTD_NZD_2015.05_eng.pdf.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Sinha S, Sharma BS, 2012. Intraventricular neurocysticercosis: a review of current status and management issues. Br J Neurosurg 26: 305–309.

  • 11.

    Bergsneider M, Holly LT, Lee JH, King WA, Frazee JG, 2000. Endoscopic management of cysticercal cysts within the lateral and third ventricles. J Neurosurg 92: 14–23.

  • 12.

    Amelot A, Faillot T, 2014. Hydrocephalus and neurocysticercosis: cases illustrative of three distinct mechanisms. J Clin Neurol 10: 363–366.

  • 13.

    Cuetter AC, Andrews RJ, 2002. Intraventricular neurocysticercosis: 18 consecutive patients and review of the literature. Neurosurg Focus 12: e5.

  • 14.

    Khade P, Lemos RS, Toussaint LG, 2013. What is the utility of postoperative antihelminthic therapy after resection for intraventricular neurocysticercosis? World Neurosurg 79: 558–567.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Tsang VC, Brand JA, Boyer AE, 1989. An enzyme-linked immunoelectrotransfer blot assay and glycoprotein antigens for diagnosing human cysticercosis (Taenia solium). J Infect Dis 159: 50–59.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Carabin H, Ndimubanzi PC, Budke CM, Nguyen H, Qian Y, Cowan LD, Stoner JA, Rainwater E, Dickey M, 2011. Clinical manifestations associated with neurocysticercosis: a systematic review. PLoS Negl Trop Dis 5: e1152.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Ramirez-Bermudez J, Higuera J, Sosa AL, Lopez-Meza E, Lopez-Gomez M, Corona T, 2005. Is dementia reversible in patients with neurocysticercosis? J Neurol Neurosurg Psychiatry 76: 1164–1166.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Rodrigues CL, de Andrade DC, Livramento JA, Machado LR, Abraham R, Massaroppe L, Lucato LT, Caramelli P, 2012. Spectrum of cognitive impairment in neurocysticercosis: differences according to disease phase. Neurology 78: 861–866.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Ciampi de Andrade D, Rodrigues CL, Abraham R, Castro LH, Livramento JA, Machado LR, Leite CC, Caramelli P, 2010. Cognitive impairment and dementia in neurocysticercosis: a cross-sectional controlled study. Neurology 74: 1288–1295.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Forlenza OV, Filho AH, Nobrega JP, dos Ramos Machado L, de Barros NG, de Camargo CH, da Silva MF, 1997. Psychiatric manifestations of neurocysticercosis: a study of 38 patients from a neurology clinic in Brazil. J Neurol Neurosurg Psychiatry 62: 612–616.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Kotha VK, 2013. Migration of intraventricular neurocysticercus after ventriculostomy. Asian J Neurosurg 8: 54–56.

  • 22.

    Schantz P, 2002. Taenia solium cysticercosis: an overview of global distribution and transmission. Singh G, Prabhakar S, eds. Taenia solium Cysticercosis: From Basic to Clinical Science. Chandigarh, India: CABI Pub., 63–73.

    • PubMed
    • Search Google Scholar
    • Export Citation
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