Obstructive Hydrocephalus secondary to Neurocysticercosis
Cysticercosis is the parasitic infection caused by the pork tapeworm, Taenia solium Humans are infected by consuming undercooked pork meat infected with cysticercosis larvae. Humans can also become infected with the eggs by ingestion of feces containing the eggs. When human eats infected pork, the larvae attaches to the small intestines and releases hundreds of thousands of eggs daily. These oncospheres, as they are called, can penetrate the intestinal wall and into the bloodstream where they can develop into cysticerci in the brain but also the subcutaneous tissue, muscle, and the eyes. (2)
In the muscle, the cysticerci cause myositis, eosinophila with fever, and muscle swelling which progress to atrophy. The majority of infections however, occur in the CNS. Neurocysticercosis has become the most common neurological parasitic infection in the world. It is also the number one cause of acquired seizure disorder. (2)
In the brain parenchyma infection can be stratified into four stages: (1)
- Stage 1 consists of oncospheres that develop one to four weeks into cysts that expand in the parenchyma. This stage is relatively an asymptomatic stage, but can cause flu-like symptoms.
- Stage 2 Cysts become mature after 2 months can cause some edema. During this stage cellular immunity is suppressed therefore suppressing eosinophilia that can last over 10 years.
- Stage 3 is an inflammatory stage caused by degenerating cysts, which leak fluid from their thickened capsule. During this stage patients present with seizures, other neurological deficits, increased intracranial pressure.
- Stage 4 cysts become calcified, and cease producing an inflammatory response. Seizures may still prevail however, during this stage.
Cysticercosis in the meninges, the cysts that predominate are comparable to stage 3 though they continue to increase in size they also continue to leak fluid into the CSF causing meningitis. Patients can develop hydrocephalus, thrombosis and even stroke.
Cysts can also implant in the intraventricular space, which can lead to obstructive hydrocephalus and increased intracranial pressure as in the case of the above patient.
In our patient, cysts where noted in the parenchyma and also along the intraventricular space which over time (4 years in this case) lead to either blockage of CSF flow or leakage of fluid causing increased intracranial pressure, headaches and abnormal gait.
Treatment for cysticercosis is albendazole or praziquantel. For neurocysticercosis, albendazole is preferred because it is not altered by the use of steroids or anticonvulsants. High dose steroids are used to decrease edema. When cysts are found to be easily accessible like in the intraventricular space or along the meninges, resection is the treatment for patients with hydrocephalus or seizures. (3)
1. Davis, LE. “Neurocysticercosis” Emerging Neurological Infections edited by Power, C and Johnson RT. Taylor & Francis Group, 2005. 261-287.
2. Mandell (2009) Chapter 290: Cestodes. Mandell, Douglas and Bennett’s Principle and Practice of Infectious Diseases, 7th ed.; Churchill Livingston. MD Consult Website https://rap.northshorelij.com/books/,DanaInfo=www.mdconsult.com+page.do?sid=1048599230&eid=4-u1.0-B978-0-443-06839-3..00290-3--s0075&isbn=978-0-443-06839-3&type=bookPage§ionEid=4-u1.0-B978-0-443-06839-3..00290-3--s0080&uniqId=217471731-4. Accessed Aug 31, 2010.
3. Rangel-Castilla L, Serpa JA, Gopinath SP, Graviss EA, Diaz- Marchan P, White AC Jr. Contemporary neurosurgical approaches to neurocysticercosis, Am J Trop Med Hyg , Mar 2009; 80(3):378-8
