Page 181 - Read Online
P. 181
space, cysts in nonconfining extraparenchymal areas Further work is required in patients with subarachnoid
can grow into interconnected grape-like clusters, and ventricular neurocysticercosis to establish the roles
known as racemose neurocysticercosis. The parasite of higher doses of albendazole, combined antiparasitic
[5]
in the extraparenchymal space degenerates owing drugs, prolonged drug courses, repeated cycles, surgical
to the continuous CSF ingress into the vesicles, interventions, and multidisciplinary collaborative
[3]
forming a hyaline mass. Histopathologically, this is a working. [2,3]
granulomatous lesion infiltrated by many multinucleate
giant macrophages. [4] REFERENCES
Treatment should be individualized, particularly for 1. Carpio A, Fleury A, Hauser WA. Neurocysticercosis: five new things.
[4]
patients with mixed forms of neurocysticercosis. Since 2. Neurol Clin Pract 2013;3:118‑25.
Del Brutto OH. Neurocysticercosis. Continuum (Minneap Minn)
extraparenchymal neurocysticercosis is associated with 2012;18:1392‑416.
a poorer prognosis, there was a consensus toward more 3. Fleury A, Carrillo‑Mezo R, Flisser A, Sciutto E, Corona T.
aggressive management. The surgical option was Subarachnoid basal neurocysticercosis: a focus on the most severe
[7]
attractive because drug penetration into the ventricular 4. form of the disease. Expert Rev Anti Infect Ther 2011;9:123‑33.
Carpio A. Neurocysticercosis: an update. Lancet Infect Dis
and subarachnoid spaces is much lower when compared 2002;2:751‑62.
with that into the brain parenchyma. Our patient received 5. Das RR, Tekulve KJ, Agarwal A, Tormoehlen LM. Racemose
endoscopic therapy, which resulted in rapid and safe neurocysticercosis. Semin Neurol 2012;32:550‑5.
reduction of the parasite burden. However, given that 6. Fleury A, Escobar A, Fragoso G, Sciutto E, Larralde C. Clinical
heterogeneity of human neurocysticercosis results from complex
not all the cysticercus can be removed completely during interactions among parasite, host and environmental factors. Trans
the surgery, antihelminthic drugs are still required. R Soc Trop Med Hyg 2010;104:243‑50.
[8]
Albendazole is the preferred choice because it has a 7. Garcia HH, Evans CA, Nash TE, Takayanagui OM, White AC Jr,
superior penetration of the subarachnoid space, reaching Botero D, Rajshekhar V, Tsang VC, Schantz PM, Allan JC, Flisser A,
Correa D, Sarti E, Friedland JS, Martinez SM, Gonzalez AE,
higher concentration in the CSF than alternative agents Gilman RH, Del Brutto OH. Current consensus guidelines for
and shows efficacy in treating both subarachnoid treatment of neurocysticercosis. Clin Microbiol Rev 2002;15:747‑56.
and ventricular cysts. Between the second and 8. Wu W, Jia F, Wang W, Huang Y, Huang Y. Antiparasitic treatment of
[9]
5th days of antiparasitic therapy, there is usually an cerebral cysticercosis: lessons and experiences from China. Parasitol
Res 2013;112:2879‑90.
exacerbation of neurological symptoms attributed to 9. Carpio A. Albendazole therapy for subarachnoid cysticerci: clinical
local inflammation due to the larval death. For this and neuroimaging analysis of 17 patients. J Neurol Neurosurg
[7]
reason, corticosteroids are given with parasiticidal drugs. Psychiatry 1999;66:411‑2.
Management of elevated intracranial pressure secondary 10. Torres‑Corzo JG, Tapia‑Perez JH, Vecchia RR, Chalita‑Williams JC,
Sanchez‑Aguilar M, Sanchez‑Rodriguez JJ. Endoscopic management
to neurocysticercosi is also a priority. In order to make of hydrocephalus due to neurocysticercosis. Clin Neurol Neurosurg
an improvement to the CSF circulation, this patient 2010;112:11‑6.
underwent endoscopic third ventriculostomy (ETV) and
VP shunt replacement. It has been reported ETV could
decrease the shunt failure rate from 36% to 8%. [10] Cite this article as: Shang C, Guan HZ, Cui LY, Hou B, Feng F, Zhong DR.
A case report on subarachnoid and intraventricular neurocysticercosis.
Neuroimmunol Neuroinflammation 2015;2(3):171-3.
The optimal duration of anti-parasitic treatment for Source of Support: Nil. Conflict of Interest: No.
extraparenchymal neurocysticercosis is not known. Received: 15-12-2014; Accepted: 10-06-2015
[7]
172 Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 173