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- Abstract -
Radiologic Findings of Cysticercosis Involving Centra\ Nervous System
Ki Hwan Kim; M.D. , Kee Hyun Chang, M.D., Ik Won Kang, M. D. , Han Chung Han , M.D.
Department of Radiology, College of Medicine, Seoul National University
Kil 500 Choi, M. D., Bo 5ung Sim , M.D.
Department of Neurosurgery, College of Medicine, Seoul National University
The diagnosis of cysticercosis of central nervous system should be considered in patients with
sei zures , sy mptoms of increased I.c. P. or focal neurologic sign , with a history of having lived in an
endemic area , particul arly in Korea. 5ince these cysts usuall y continue to grow and medical treatment
is very limited it is important to id entify them and co nsider th~ feasib ility of removing them surgically.
20 cases of surgically proven cysticercosis of the central ncrvous system were radiologica lly analyzed , experienced at 5eoul National University Hospita l. Radiologic studies include plain radiography of the
skull , angiography, ventriculography, and CT scanning which is especia lly effective in diagnosis of
diffuse parenchymal cysticercosis.
The results are as follows:
1. Male to female ratio is 11:9 and mean age o f the patients is 36 years. The cardinal symptoms
and signs are seiz ures (50%), symptoms of increased I.c. P. (45 %), mental change (20%) and
focal neurologic sign (20 %).
2. The distribution of cysts are cerebral parenchymal (40%), 4th ventricle (30%), 3rd ventricle (10%),
leptomeningea l (30%), and intraspinal fo rm (1 5%).
3. 5imple skull film shows sign of increased I.c. P. (25 %) but no case of calcifi e<ition . In carotid
angiography hydrocephalus is detected in all 13 cases. Displace ment of adjacent vessels is seen
in 2 cases of parenchymal form . Ventriculography shows di la ted ventricles with free f loating
avoid filling defect in intrave ntricular form and 4th ve ntricle outlet obstruction in leptomeningeal
form.
4. Of sp inal cysticercosis 2 cases are leptomeningea l and 1 case intramedu Ll ary form. 2 cases a re
fou nd in cervical portion and 1 case in cauda eq uina region.
Myelography reveals fi lling defect not dist inguishab le from other tumorous condition.
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5. On CT scanning variable degree of hydroce phalus is seen including roundc.symmetric expansion
of cyst-containing ventricle. In le ptome ningeal form enlarged cisterna magna is demonstrated
without any enhancement or outline of cystic wall . In parenchymal form there are multiple
round areas of low density with slight ring-enhancement in postcontrast study.
6. CT is very helpful to determine surgical indicatio l'), to evaluate the function of VA 'shunt and
to detect the appearance of new cysts in post-operative patients.
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S tudy Finding No . of Cases
Plain Sku l1 Ca lcifi cation 0/ 20
lncreased 1. C. P.
Local mass effect
Fi \1 ing d efect in V. with h ydroce phalus
4th V. outlet 0 bstruction
Aqueducta l stenosis
H ydroc ephalu s including 3rd V
Cerebral Angiography
2/14
5/10
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e nh ancement. P ar e nchymal lo w densit y with or without 4/10
La r ge cistern wi th hy drocepha lus
Ca lcifi catio n
Location No. of Cases
V entri c1 e, 4th 6
2 3rd
Spinal Cervical
Lumbar ’ 2
* 2 cases of combined 4th V. and cere brum. ** 2 cases of combined 4th V. and arachno-
iditis ’ A case of com bined 4th V. and cauda eq -
uina lesion.
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Fig. 1. Smooth o utlined floatin g fi \1 ing defect in 4th ventr ic1 e, w hich is charact e ris tic f indi ng of cyst icercos i s.
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Fig.4. Hydrocephalus with multiple round low Fig.2. 4th ventricular cysticercosis. densities in cerebral hemisphere.
Round symmetric e xpansion of 4th ven- Slight ring enhancement around the cys- tricle. tic lesion (right). No enhancement in postcontrast study This patient al so h as 4th ventricular cy- (right). sticercosis.
Fig. 3. Cysticercosis in cisterna magna. Fig. 5. Ri ng enhancement of the hypodense cy- Marked hydrocephalus with symmetric stic lesion(ri g ht ) with surrounding ede- expansion of cisterna magna. ma of low density. No enhancement(right).
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Fig.6. Variable sized multiple round low dens­ ities with s li gh t enhancement on perip­ her al rim. Ipsilatera l sh ifting of left lateral ventr­ icle.
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Table 111. Bri ef C T finding s related wi th ventriculo graphic features and loca tion of cysts.
No. Case Age. S ex Distribution
Han MK 21 F 4th V.
2 Lee MH 13 F 4th V .
3 Lee IC 12 M 4th V .
4 Sim MS 37 M 4th V. parietal
5 Chung KS 32 M ‘ 4th V.
6 Lee HJ 46 ‘ F 3rd V.
7 Ahn SS 47 F cisterna
8 Mun KW 47
9 Chang MS 47
magna
Ventriculography CT scanning
Filling defect in 41th V. Hydrocephalus including with hydrocephàlus 4th V.
Filling defect in 4th V. Hydrocephal us incl uding wi th hydro cephal us 4th V.
4th V . outlet obstruction Hydrocephalus încluding with hydrocephalus 4th V .
Filling defect in 4th V . * Hypodense area in par. with hydroc ephalus ietal , hydrocephalus incl .
uding 4th V.
Filling defect in 4th V. Hydrocephalus including with hydrocephalus 4th V .
Filling defect in 3rd V. Hydrocephalus including with hydrocephalus 3rd V
Hydrocephalus Large cisterna magna wi th hydrocephal us
**Multiple cysts in cere. bral hemis phere with sli. ght ring enhancement
Low densit y with s light ring enhancem ent
Small low density without enhancement
* ... .. . Slight s taining in angiography. ** .. ... mass effect in a ng iography.
Table IV . Frequency of presenting symptoms and signs in patients with cysticercosis.
Study Stepien Arseni Kim
Seizure 49 37 % 26 40 % 10 50 %
Increased 1. C. P. 129 98 52 80 2 40
A ltered Mental statu s 36 28 8 12 4 20
Focal ne uro. abnorm. 128 97 0 0 4(2) 20
SQ nodul e 0 0 0 0 5
) ... .. Spi nal cysticercosis

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Study Dixon Arseni Kim
Cerebellum 8 18
Ventricle 8 18
Leptomeningea! 21 45
Spina! 2 4
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7: 417-425 , 1978.
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1 • 11 : 9
36 2~
3 f13f: (50% ) ,
( 4 5% ) , (20% ) , llE
(20%) .
2. 40% , 40 % ,
( 4 75 %, 3 25 % ), 30 %.
15 % .
3 0 25 % 2
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ShW1 t
.
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