0521779407-C04 CUNY1086/Karliner 0 521 77940 7 June 14, 2007 20:37
456 CysticercosisSigns & Symptoms
■Neurocysticercosis: often no symptoms. May present with seizures
(most common presentation), focal neurologic signs, or chronic
headache (from increased intracranial pressure).
■Cysticercosis elsewhere: SQ nodules, about 1–2 cm in size. Occasion-
ally retro-orbital or subretinal.tests
■Basic tests: blood: CBC, chemistries are normal
■Basic tests: urine: normal
■Specific tests: neurocysticercosis: MRI or CT scans are suggestive,
and in endemic areas probably diagnostic. MRI preferred as CT
will not show cysts in ventricles. MRI and CT also help determine
viability and stage of degeneration of cysts, and assess if hydro-
cephalus present. Serology, using immunoblot technique (done at
CDC), about 98% sensitive if multiple cysts, about 70% if one cyst,
and highly specific. Immunoblot serology on CSF has same accuracy.
➣Cysticercosis elsewhere: Biopsy of SQ nodule is diagnostic. Soft
tissue X-rays of muscles (or cranium) can show calcified cysts if
old enough (>5 years).
■Other tests: CSF exam can be normal or show increased cells, mainly
lymphocytes. Eosinophils often present but require staining to see.differential diagnosis
■Neurocysticercosis: tuberculoma, neoplasm, other types of cysts,
abscess or focal area of infection by bacteria, fungus, or toxoplas-
mosis
■Cysticercosis elsewhere: fibromas, lipomas, sebaceous cystsmanagement
What to Do First
■Assess patient for presence of both intracranial and extracranial dis-
ease. If intracranial, assess for hydrocephalus, and stage of cysts (ring
enhancement implies leakage of antigen and early degeneration, cal-
cium implies later stage or dead cyst). Assess for presence ofTaenia
soliumin bowel by stool exam and asking about passing segments
(eggs not always seen on stool exam). TreatT. soliumif present.General Measures
■Control seizures with anticonvulsants, and hydrocephalus with
steroids and possible shunting.