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Title : A 62 year-old male w/ headache
Date : January 3, 2011
Contributed by

Eun Jeong Joo, MD

Samsung Medical Center, Seoul, Korea

Patient History
Age/Sex 62 year-old male
Chief complaint Headache which had developed one year ago and been recently aggravated
Present illness

The patient presented to Samsung medical center headache which had developed one year ago and been recently aggravated. Within a month prior to visit, right side weakness was noticed and brain MRI was performed.

Past medical history

There was no specific past medical history.

Physical examination

He was afebrile at the time of visit and motor power and sensory of his lower extremities was intact in neurologic examination.

Initial laboratory findings

CBC 6390-14.3-200K (segmented neutrophil 40%, eosinophil 1.7%)

Total bilirubin 0.6, AST/ALT 14/12

BUN/Cr 17.3/0.9

CRP 0.03 

 

Parasite Ab (ELISA)

Clonorchis (-)

Paragonimus (-)

Cysticercus (-)

Sparganum (-)

 

Radiologic findings
Hospital course

Craniostomy and mass removal was attempted in him with the suspicion of brain tumor.

Inside of calcified lesions, three cystic worms have been observed.


 
Question - ID Case of the Week ( January 3, 2011 )
What do you think the most likely diagnosis is ?
 
Correct Answer

Neurocysticercosis (NCC)

 
Review

The helminth is among the most prevalent infection in the world and a leading cause of morbidity in developing areas. The helminthes that parasitize humans include the nematodes (roundworms), cestodes (tapeworms) and trematodes (flukes). Cestodes are the subclass of segmented worms comprising the tapeworms incuding Taenia saginata (beff tapeworm), Taenia solium (port tapeworm) and Echinococcus species.

 

 As one of cestodes, Taenia solium is causing neurocysticercosis (NCC). It is the most common helminthic infection of the CNS and a leading cause of acquired epilepsy worldwide. Mexico, Central America, South America, the Philippines and Southeast Asia are well known as endemic areas.

 

 NCC results from ingestion of the eggs of T. solium which has a complex life cycle, requiring two hosts. Humans are the definite host whereas pigs are the intermediate host. The larva hatch in the intestine, penetrate the intestinal wall and disseminate to several body tissues, showing strong tropism to the CNS. NCC is an infection of the brain by the larval state of the T. solium. There are four forms of neurocysticercosis consisting of parenchymatous, meningeal, intraventricular/subarchnoid and spinal forms.

 

 Since 1986, brain imaging combined with antibody tests (ELISA) became routine procedures in diagnosing NCC in Korea. In Korea, more than 3,000 NCC patients were diagnosed by this method during past 2 decades.

 

Treatment modalities available to patient with NCC include cysticidal agents, corticosteroids, anti-epileptic drugs and surgery. As for cysticidal drugs, albendazole and praziquantel are effective in all forms of NCC. Albendazole is much more effective than praziquantel in several trials. Other points favoring albendazole are its efficacy against meningeal, subarchnoid and ventricular cysicerci and its lower cost.

 

 

References

Sumit Sinha, B.S. Sharma, Journal of Clinical Neuroscience, 2009;16:867-76

Cho SY, Korean Journal of Parasitology, 2009; 49(suppl):S1-19

Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 7th Ed.:3607-16

 


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