Neurocystercisosis Flashcards
outline classification of neurocystercisosis
Patient with subarachnoid neurocystercisosis.
How to treat?
Give everything.
- anti-parasitic (till complete lesion resolution, may be longer than 1 year)
- steroids/methotrexate
- surgery
Viable intraparenchymal neurocystercisosis with edema and hydrocephalus.
How to manage?
NO ANTIPARASITIC DRUGS
- Edema = give steroids
- hydrocephalus = shunt
- If seizures, anti-epileptics.
Pregnant woman with neurocystercisosis.
How to manage?
If no raised ICP, defer antiparasitic treatment till after delivery.
If raised ICP, treat aggressively as if non-pregnant.
Can use steroids and anti-epileptics in pregnancy (avoid valproate and phenobarbital)
Calcified parenchymal lesion. Pt asymptomatic.
How to manage?
Do nothing. no need for MRI FU either (unless develops new symptoms).
In viable parenchymal neurocystercisosis, who should get anti-epileptics?
For how long?
All patients with seizures.
Can TAPER DOWN if relatively few seizures pre-therapy, resolution of lesions and seizure-free for 24 months.
Single enhancing lesion (<2cm) neurocystercisosis lesion on MRI. has seizures.
Treated with steroids, albendazole and anti-epileptic.
What follow up is needed?
MRI every 6 months till cystic lesions resolve.
Ocular neurocystercisosis.
How to treat?
Surgery.
DON’T GIVE ANTIPARASITIC.
Calcified parenchymal lesion. patient having seizures. MRI showed small focus of perilesional edema.
Despite anti-epileptics, seizures still uncontrolled.
How to manage?
May consider brain surgery.
Patient with spinal neurocystercicosis.
How to treat?
anti-parasitic drugs
steroids (if evidence of cord compression)
surgery
Identify this egg (45 microns)
Tinea egg
(indistinguishable between T.solium and T.saginata)
Calcified neurocyscerticosis on CT. No seizures, no hydrocephalus. No symptoms.
How to treat?
Send serology.
MRI to exclude brain tumour.
Observe. No need for antiparasite.
Maximum 2 viable intraparenchymal lesion. no signs of raised intracranial pressure.
How to manage?
Albendazole monotherapy 15mg/kg in two divided doses for 14 days.
Going to start therapy for neurocystercisosis as per MRI. Prior to initiation, what needs to be done?
- screen for latent TB if may need prolonged steroids
- screen/empirical therapy for strongyloides for pts needing prolonged steroids.
- fundoscopy to exclude ocular neurocystercisosis
- If pt from non-endemic area, screen household contacts as well.
Man had intraparenchymal neurocystercisosis, finished anti-parasitic treatment. What follow-up now?
MRI at 6 monthly intervals till resolution of cystic component.
Retreatment with antiparasitic therapy for parenchymal cystic lesions persisting for 6 months after the end of the initial course of therapy.
Single enhancing lesion (<2cm) neurocystercisosis lesion on MRI. has seizures.
How to treat?
- steroids
- albendazole 14 days
- anti-epileptics - taper off once lesions resolved +low risk for recurrent seizures+seizure free for 6 months
Low risk for recurrent seizures if: no residual calcification/cysts, no break through seizures, _<_2 seizures
Patient with intraparenchymal lesions. Previously treated for 14days, but persists at 6 months since completing treatment.
What to do?
Repeat 14 day treatment course
(if 1 or 2 = albendazole monotherapy)
(if >2 = albendazole+praziquantel)
CT highly suggestive of neurocystercisosis. How to investigate further?
- MRI to classify
- Serology with enzyme-linked immunotransfer blot (not crude antigen)
Calcified parenchymal lesion. patient having seizures. MRI showed small focus of perilesional edema.
How to manage?
- anti-epileptics. Consider stopping once seizure free for 2 years.
- no evidence for steroids or anti-epileptics.
Patient suspected of having intraventricular/subarachnoid neurocystercisosis.
What is best imaging modality?
MRI with 3D sequencing
Patient with neurocystercisosis in lateral/third/fourth ventricles.
How to treat?
- Minimally invasive neuroendoscopy
- Steroids pre-op
- Avoid anti-helminths as may disrupt parasite
If can’t remove with surgery…
=shunt for hydrocephalus+give steroids+antihelminths
More than 2 viable intraparenchymal lesions, without raised intracranial pressure.
How to treat?
Dual therapy = albendazole + praziquantel for 14 days
Child with neurocystercisosis.
Does management differ from adults?
No.
Manage exactly as per adults - with weight-based dosing.
