Neurocysticercosis and its management in pediatric age group.difference between neurocysticrcosis and tubercuolma based on imaging.Life cycle of Neurocysticercosis.
2. Contents
Introduction to Taeniasis
Lifecycle of Taenia solium
Anatomical Classification of NCC
Stages of cyst formation
Diagnosis
NCC vs Tuberculoma based on imaging
Management of parenchymal NCC
Prevention and control
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4. Taeniasis
Taeniasis is the infection of humans with the adult tapeworm
of Taenia saginata, T. solium or T. asiatica
Taenia solium (pork tapeworm) is the main cause of human
cysticercosis
Cysticercosis
Caused by the presence, of the larval forms of
Taenina solium i.e Cysticercus cellulosae and Cysticercus racemose
T. saginata i.e Cysticercus bovis occurs very rarely
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7. Clinical features
Diverse clinical presentation of NCC is determined by:
Location of cysts
Size of cysts
Cyst load (number of cysts)
Host’s immune response
9. Parenchymal NCC
Seizures (87%)
Simple partial with secondary generalization
Generalized tonic-clonic
Complex partial or complex partial with secondary generalization
Headache, nausea and vomiting
Stroke
Hemiparesis
Focal neurologic deficits
Frontal lobe involvement
Psychosis, dementia, intellectual impairment
10. Intraventricular NCC
5- 10% of all cases
4th ventricle :Most common site for obstruction
Up to 20% of cases is associated with obstructive
hydrocephalus and signs of raised ICP
11. Meningeal NCC
Meningeal irritation resembling Tubercular meningitis
Raised ICP from inflammation, oedema and presence of
cyst obstructing flow of CSF
12. Spinal NCC
– Spinal cord compression
– Nerve root pain
– Transverse myelitis
Ocular NCC
– Visual impairment (decreased visual acquity)
– Retinal detachment, iridocyclitis
iridocyclitis - inflammation of the iris and ciliary body of the eye
13. 1. Vesicular stage
Viable parasite with intact membrane and therefore no host
reaction
2. Colloidal vesicular stage
Parasite dies and the cyst fluid becomes turbid
As the membrane becomes leaky oedema surrounds the cyst
Most symptomatic stage
Stages of Cyst Formation
16. Diagnosis
Fundoscopy
CT with contrast
MRI: Cyst location, viability, and associated inflammation
Serology
Enzyme-linked immunotransfer blot (EITB): serologic diagnosis
sensitivity of 98% specificity of 100%
ELISA in CSF
sensitivity of 87% specificity of 95%
Biopsy and histopathology
18. Cysticercus Granuloma Tuberculoma
Round in shape Irregular in shape
Cystic Solid
20 mm or less with ring
enhancement or visible scolex
Greater than 20mm
Cerebral edema not enough to
produce midline shift
Severe perifocal edema, midline
shift and raised ICP
Usually focal neurological deficit is
not present
Focal neurological deficit
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19. Contd..
CECT of Brain showing degenearting cyst
with eccentric scolex with perilesion edema
in rt frontal lobe
Caseating granulomatous inflammation
associated with a fibrous type capsule,
20OP ghai, pediatrics
21. Anticonvulsant Therapy
Management of seizure due to NCC
Phenytoin or carbamazepine or sodium valporate
Upto 6 to 12 months after radiographic resolution of active
parasitic infection
If seizures are recurrent or associated with calcified lesions:
should be continued for 2-3 yr before attempting weaning from
anticonvulsants
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22. Prior to Therapy
These condition should be ruled out prior to initiating
anti parasitic and steroid therapy
Tuberculosis
Ocular cysticercosis
Strongyloidiasis
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23. Anti-Parasitic Therapy
Albendazole:
Most commonly used antiparasitic (15 mg/kg/day PO in two daily
divided dose)
Can be taken with a fatty meal to improve absorption
Most common duration of therapy is 7 days for parenchymal
lesions
For multiple lesions or subarachnoid disease
longer duration(8-15 days), higher doses (up
to 30 mg/kg/day), or combination therapy with praziquantel
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25. Steroids
Prednisone 1-2 mg/kg per day or oral dexamethasone 0.15
mg/kg per day
Should be started before the first dose of antiparasitic
drugs and continuing for at least 2 wk
Methotrexate :
used as a steroid-sparing agent in patients requiring
prolonged antiinflammatory therapy
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26. Indication of Surgery
Symptomatic hydrocephalus due to NCC
NCC of ventricle
Giant cysticerci with life-threatening mass effect
cysticerci adjacent to vascular structures
Ocular and spinal NCC
Giant cysticerci : Rare condition defined as size in its largest dimension 27
27. Follow up and monitoring
Intermittent radiographic surveillance to evaluate for resolution of
the cysticerci and development of calcifications
Imaging at 1 to 2 month and 6 month
Imaging should be repeated prior to discontinuing antiepileptic
drugs
Antiparasitic therapy should be considered for patients with growing
cysts off therapy 28
28. Prevention and Controll
Wash hands with soap and warm water after using the toilet,
changing diapers, and before handling food
Wash and peel all raw vegetables and fruits before eating
Adequate cooking of meat products
Storage of meet in freezing condition*
Veterinary vaccines for several cestode infections
Note *: (Cysticerci do not survive temperatures below -10o C and above 50o C)