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Parasites > Neurocystercisosis > Flashcards

Neurocystercisosis Flashcards

1
Q

outline classification of neurocystercisosis

A
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2
Q

Patient with subarachnoid neurocystercisosis.

How to treat?

A

Give everything.

  • anti-parasitic (till complete lesion resolution, may be longer than 1 year)
    • steroids/methotrexate
    • surgery
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3
Q

Viable intraparenchymal neurocystercisosis with edema and hydrocephalus.

How to manage?

A

NO ANTIPARASITIC DRUGS

  • Edema = give steroids
  • hydrocephalus = shunt
  • If seizures, anti-epileptics.
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4
Q

Pregnant woman with neurocystercisosis.

How to manage?

A

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)

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5
Q

Calcified parenchymal lesion. Pt asymptomatic.

How to manage?

A

Do nothing. no need for MRI FU either (unless develops new symptoms).

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6
Q

In viable parenchymal neurocystercisosis, who should get anti-epileptics?

For how long?

A

All patients with seizures.

Can TAPER DOWN if relatively few seizures pre-therapy, resolution of lesions and seizure-free for 24 months.

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7
Q

Single enhancing lesion (<2cm) neurocystercisosis lesion on MRI. has seizures.

Treated with steroids, albendazole and anti-epileptic.

What follow up is needed?

A

MRI every 6 months till cystic lesions resolve.

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8
Q

Ocular neurocystercisosis.

How to treat?

A

Surgery.

DON’T GIVE ANTIPARASITIC.

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9
Q

Calcified parenchymal lesion. patient having seizures. MRI showed small focus of perilesional edema.

Despite anti-epileptics, seizures still uncontrolled.

How to manage?

A

May consider brain surgery.

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10
Q

Patient with spinal neurocystercicosis.

How to treat?

A

anti-parasitic drugs

steroids (if evidence of cord compression)

surgery

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11
Q

Identify this egg (45 microns)

A

Tinea egg

(indistinguishable between T.solium and T.saginata)

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12
Q

Calcified neurocyscerticosis on CT. No seizures, no hydrocephalus. No symptoms.

How to treat?

A

Send serology.

MRI to exclude brain tumour.

Observe. No need for antiparasite.

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13
Q

Maximum 2 viable intraparenchymal lesion. no signs of raised intracranial pressure.

How to manage?

A

Albendazole monotherapy 15mg/kg in two divided doses for 14 days.

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14
Q

Going to start therapy for neurocystercisosis as per MRI. Prior to initiation, what needs to be done?

A
  1. screen for latent TB if may need prolonged steroids
  2. screen/empirical therapy for strongyloides for pts needing prolonged steroids.
  3. fundoscopy to exclude ocular neurocystercisosis
  4. If pt from non-endemic area, screen household contacts as well.
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15
Q

Man had intraparenchymal neurocystercisosis, finished anti-parasitic treatment. What follow-up now?

A

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.

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16
Q

Single enhancing lesion (<2cm) neurocystercisosis lesion on MRI. has seizures.

How to treat?

A
  • 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

17
Q

Patient with intraparenchymal lesions. Previously treated for 14days, but persists at 6 months since completing treatment.

What to do?

A

Repeat 14 day treatment course

(if 1 or 2 = albendazole monotherapy)

(if >2 = albendazole+praziquantel)

18
Q

CT highly suggestive of neurocystercisosis. How to investigate further?

A
  1. MRI to classify
  2. Serology with enzyme-linked immunotransfer blot (not crude antigen)
19
Q

Calcified parenchymal lesion. patient having seizures. MRI showed small focus of perilesional edema.

How to manage?

A
  • anti-epileptics. Consider stopping once seizure free for 2 years.
  • no evidence for steroids or anti-epileptics.
20
Q

Patient suspected of having intraventricular/subarachnoid neurocystercisosis.

What is best imaging modality?

A

MRI with 3D sequencing

21
Q

Patient with neurocystercisosis in lateral/third/fourth ventricles.

How to treat?

A
  • 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

22
Q

More than 2 viable intraparenchymal lesions, without raised intracranial pressure.

How to treat?

A

Dual therapy = albendazole + praziquantel for 14 days

23
Q

Child with neurocystercisosis.

Does management differ from adults?

A

No.

Manage exactly as per adults - with weight-based dosing.

Parasites (2 decks)

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