A 33-year-old female Peruvian patient presented with a 10-year history of secondary generalized seizures. Initial neuroimages showed brain lesions compatible with cysticercosis including an extensive subarachnoid lesion in the right temporo-parietal convexity and multiple intraparenchymal viable cysts and calcifications. She received a course of albendazole (ABZ) at 15 mg/kg/d, stopped at day 15 because of increased liver enzymes that returned to normal values after suspension of ABZ treatment. The subarachnoid lesion markedly decreased in size, and most parenchymal cysts resolved. After 1 year, a ventricle-peritoneal shunt was placed, and a second course of ABZ was needed because of re-growth of the sub-arachnoid lesion and persistence of four viable parenchymal cysts. All cysts resolved after a second course of anti-parasitic treatment. Neurocysticercosis is a frequent cause of seizures in most of the world. This case illustrates the effect of anti-parasitic therapy to kill parasite cysts, the frequent need for successive courses of therapy, and the potential of subarachnoid lesions to grow and cause obstructive hydrocephalus. Even after successful anti-parasitic treatment, the remaining calcified scars persist, acting as foci of relapsing inflammation and seizures.
Left, Magnetic resonance image showing intraparenchymal cysts and a wide subarachnoid cyst in the subarachnoid space of the convexity. Right, Three-dimensional and multiplanar computed tomography scan reconstruction 30 days after a second course of anti-parasitic treatment, showing multiple residual calcifications and a ventricle-peritoneal shunt system. The scan was performed at 3-mm intervals in a Siemens Somatom Plus IV Helical scanner (Erlangen, Germany).
Citation: The American Journal of Tropical Medicine and Hygiene Am J Trop Med Hyg 78, 3; 10.4269/ajtmh.2008.78.363
Left, Magnetic resonance image showing intraparenchymal cysts and a wide subarachnoid cyst in the subarachnoid space of the convexity. Right, Three-dimensional and multiplanar computed tomography scan reconstruction 30 days after a second course of anti-parasitic treatment, showing multiple residual calcifications and a ventricle-peritoneal shunt system. The scan was performed at 3-mm intervals in a Siemens Somatom Plus IV Helical scanner (Erlangen, Germany).
Citation: The American Journal of Tropical Medicine and Hygiene Am J Trop Med Hyg 78, 3; 10.4269/ajtmh.2008.78.363
Left, Magnetic resonance image showing intraparenchymal cysts and a wide subarachnoid cyst in the subarachnoid space of the convexity. Right, Three-dimensional and multiplanar computed tomography scan reconstruction 30 days after a second course of anti-parasitic treatment, showing multiple residual calcifications and a ventricle-peritoneal shunt system. The scan was performed at 3-mm intervals in a Siemens Somatom Plus IV Helical scanner (Erlangen, Germany).
Citation: The American Journal of Tropical Medicine and Hygiene Am J Trop Med Hyg 78, 3; 10.4269/ajtmh.2008.78.363
Address correspondence to Hector H. Garcia, Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Av Honorio Delgado 430, SMP, Lima 31, Peru. E-mail: hgarcia@jhsph.edu
Authors’ addresses: Javier A. Bustos, Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Jr. Ancast 1271, Barrios Altos, Lima 01, Peru. Edinson Montoya, Department of Radiology, Instituto Nacional de Ciencias Neurológicas, Jr. Ancash 1271, Barrios Altos, Lima 01, Peru. Hector H. Garcia, Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Av Honorio Delgado 430, SMP, Lima 31, Peru, E-mail: hgarcia@jhsph.edu.
Acknowledgments: The authors thank Dr. Lizardo Mija and CT Technologist Ruben Dorregaray for contributions to this work.