TWO STAGES IN NEUROIMAGING OF PARENCHYMAL NEUROCYSTICERCOSIS

1. INTRODUCTION
Neurocysticercosis (NCC) is a neurologic infection caused by the larval stage of the
tapeworm Taenia solium. It is one of the seven neglected endemic zoonoses targeted by the
World Health Organization. In the developing countries, the infection of the central nervous
system (CNS) due to the Taenia solium larvae, is the most common cause of acquired
epilepsy. The prevalences of taeniasis/cysticercosis in Indonesia were between 1-42.7%,
mostly found in three provinces : North Sumatra, Bali, and Irian Jaya. The adult tapeworm
develops in human hosts after they ingest live cysticercus in undercooked pork. Recent
advances in neuroimaging and immune diagnostic methods (the enzyme-linked immune
electrotransfer blot( EITB)) have enhanced its accuracy for the diagnosis of NCC. CT
scanning or MRI after the intravenous administration of contrast material is the imaging test
of choice, besides the immune assay. NCC divided into four pathologic stages : vesicular,
colloidal, granular nodular, and nodular calcified. From all the neuroimaging forms of
presentation of cysticerci, only the presence of cystic lesions demonstrating the scolex can be
considered pathognomonic of NCC.

2. OBJECTIVE
This is a case report to describe how cysticercus affect central nervous system in human
brain. The clinical manifestation of neurocysticercosis in this patient was behavorial
disorders, with history of focal seizure and post non-hemorrhagic stroke. We try to describe
the pathognomonic signs of neuroimaging study in neurocysticercosis.

3. METHOD
A 58 years old- male patient with chief complaint incoherent speech with behavorial disorder
and also memory loss since 5 days ago. This patient also complaint about loss of appetite. He
had a habit of recreational boar hunting in forest and ate undercooked pork during his hunting
sessions. He had a history of non-hemorrhagic stroke on October 2017 along with
hypertension and type II diabetes mellitus with sequele of left slight hemiparese. He was
admitted to other hospital on November 2017, diagnosed with non-hemorrhagic stroke,
manifested in focal seizure and underwent a computed tomography (CT) of the brain (on
November 6th 2017) that only showed minor infarct in the brain. On January 2nd 2018, in our
hospital, he underwent a magnetic resonance imaging (MRI) of the brain without contrast
because of high level of blood creatinin, that revealed multiple parenchymal
neurocysticercosis, mostly in colloidal stage and small part in nodule calcified stage. On
T2FSE shows multiple cysts subcentimeter hyperintens lesions with hypointens “dot”
inside it at the area of bilateral cerebellum, left pons, right dorsal mescencephalon, cortical,
and bilateral subcortical temporoocipital, bilateral frontal, bilateral parietal, bilateral base of
ganglia, bilateral thalamus, bilateral body of callosum, bilateral corona radiata, and bilateral
semiovale centrum, with T1 SE shows hypointense cysts with centric and eccentric
hyperintense area inside of it. On T2 Fat Sat Dark Fluid shows perifocal edema on most of
the lesions. On SWI, some lesions show dark signal focal. After that examination, he was
admitted to national brain centre for one day and was treated with anthelmintic drugs. About
five days later, he was admitted to our hospital and he received treatment with 2 weeks of
oral anthelmintic drug and other symptomatic drugs.
4. RESULT
Neurocysticercosis was treated with oral anthelmintic drug Albendazole 400 mg twice a day
for 14 days. This patient was also treated with several anticonvulsion drugs, steroids and
other symptomatic drugs. The follow up of neuroimaging (Brain MRI) 14 days later after
treatment shows cystic lesions decreased in size and perifocal edema decreased.

5. CONCLUSION
Neurocysticercosis (NCC) is a neurologic infection caused by the larval stage of the
tapeworm Taenia solium. It is the common cause of acquired epilepsy. Neuroimaging for
diagnostic is an examination that can show pathologic stages in neurocysticercosis, besides
the immune diagnostic assay. The primary prevention should be the most effective way to
eradicate cysticercal infection such as reducing transmission from pig to human and
improving sanitary conditions, besides the anthelmintic drugs and other symptomatic drugs.