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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]





























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