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Case Report

A case report on subarachnoid and

intraventricular neurocysticercosis

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Chen Shang , Hong‑Zhi Guan , Li‑Ying Cui , Bo Hou , Feng Feng , Ding‑Rong Zhong 3
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1 Department of Neurology, Peking Union Medical College Hospital, China Academy of Medical Science, Beijing 100730, China.
2 Department of Radiology, Peking Union Medical College Hospital, China Academy of Medical Science, Beijing 100730, China.
3 Department of Pathology, Peking Union Medical College Hospital, China Academy of Medical Science, Beijing 100730, China.
ABSTRA CT
Neurocysticercosis is the most common central nervous system helminthic infection in humans. We hereby present a
case combining two rare manifestations of neurocysticercosis: the subarachnoid and intraventricular forms. The patient
presented with hydrocephalus and neurologic deficits and although endoscopic removal of the cysts and two cycles of
postoperative cysticidal drugs resulted in resolution of symptoms, they later recurred. Ventriculoperitoneal shunt placement and
a further cycle of albendazole plus dexamethasone led to substantial clinical improvement. Extraparenchymal neurocysticercosis
may be challenging to diagnose and treat and is usually associated with a poorer prognosis. Clinicians should be aware of
this condition.
Key words: Antiparasitic drug, extraparenchymal neurocysticercosis, intraventricular neurocysticercosis, neuroendoscopic surgery,
subarachnoid neurocysticercosis

INTRODUCTION CASE REPORT

Neurocysticercosis is caused by a human infestation of A 56-year-old Chinese man was sent to our hospital
larvae of the tapeworm taenia solium and is considered for further evaluation and treatment. Approximately,
the most common helminthic infection of the 2 years prior to admission, he developed chronic
human central nervous system. The disease presents headache with nausea intermittent dizziness, hearing
significant diagnostic and therapeutic challenges. It loss, bradyphrenia, and mild lower limb weakness
has heterogeneity in both clinical manifestation and without remarkable findings on neurological
therapeutic response [1,2] and mortality and morbidity examination besides bilateral optic disk edema
rates remain high. [3] cerebrospinal fluid (CSF) studies showed intracranial
hypertension (opening pressure ≥ 330 mmH O) and a
2
Here, we describe a patient with subarachnoid CSF leukocytosis of 30 × 10 /L (90% lymphocytes, 5%
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and intraventricular neurocysticercosis who had monocytes, 3% neutrophils, and 2% eosnophils). Brain
hydrocephalus and neurologic deficits for several magnetic resonance imaging (MRI) showed widened
years, received successive surgical interventions, sulci and cisterns bilaterally, as well as enlargement
postoperative drug therapies, and finally, the placement of the subarachnoid spaces. He stated that he used
of a ventriculoperitoneal (VP) shunt. Shunting proved, to eat under-cooked meat. Serum immunoblot for the
in this case, to be an effective treatment, and this may anticysticercal antibodies was equivocal. The assay
prompt its wider use in the treatment of the mixed form of CSF anticysticercal antibodies was positive, and a
of extraparenchymal neurocysticercosis. presumptive diagnosis of neurocysticercosis causing
significant hydrocephalus was made.
Access this article online
Quick Response Code: A transfrontal transventricular endoscopic excision
Website: and third ventriculostomy were undertaken to relieve
www.nnjournal.net
the clinical symptoms. Thickening of the arachnoid
DOI: membrane underneath the third ventricle was found
10.4103/2347-8659.160858 and upon fenestration of the arachnoid to the basic
cistern, a multitude of whitish cystic structures with

Corresponding Author: Dr. Hong‑Zhi Guan, Department of Neurology, Peking Union Medical College Hospital, China Academy of
Medical Science, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, China. E‑mail: guanzhaoduoduo@hotmail.com

PB Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 171