neuro ocular cysticercosis
DESCRIPTION
taenia solium in brain & eye.. diagnosis is clinico- radiologicalTRANSCRIPT
NEURO-OCULAR CYSTICERCOSIS
By: Dr Rekha Khare
MD.Radiology
Cysticercosis
It is an infection by a parasite Taenia solium, a pork tapeworm forms cysts in different parts of body
Neurocysticercosis
It is parasitic infestation affecting CNS in about 90%
patients with cysticercosis a
common neurological disease
in developing countries
Taenia solium
Two host zoonotic cestode Adult stage lies in small intestine
of human Gravid proglottid at terminal end
of worm full of eggs that are source of infection with larval stage/ cysticercosis
Taenia solium contd…..
Intermediate host is pig harvouring larval cyst anywhere in it’s body
Human gets infected with cyst by accidental ingestion of T. solium eggs by fecal- oral contamination
Clinical presentation
Depends on:
site of lesion
number of lesion
host immune response
Sites for Neurocysticercosis
Meningeal_ basal meninges Parenchymal cerebral cortex
rarely white matter Ventricular_ 50%cases in 4th Spinal cord rare_ blood or
ventriculo-ependymal spread
Neuro-symptoms/signs
Fits/ seizures/ epilepsy-70% Stroke/ TODD paralysis Headache/ Hydrocephalus Neuropsychiatric dysfunction
Ocular cysticercosis
In 5% cases of cysticercosis Cyst may float freely in
anterior/ vitreous chamber Cyst may adhere to retinal &
sub retinal tissue Rarely in eyelid & lacrimal
gland
Ocular- symptoms/signs
Chorioretinitis Vitreous detachment Diminution/ loss of vision patient complaints of painful, swollen
eye with gradual loss of vision
CT findings…..
Depends on stage of evolution of infestation
1.Vesicular stage -viable
Hypo dense nonenhancing lesion
2. Colloid stage- degeneration
Hypo/ isodense lesion with peri.
lesional enhancement/ oedma
CT finding contd…..
3.Nodular Granular stage nodular enhancing lesion
4.Active parenchymal stage
scolex within a cyst may appear
as a hyper dense dot
CT finding contd…..
5.Calcified stage- parasite dies nodular parenchymal calcification
6.Cysticercotic encephalitis diffuse oedma, collapsed ventricle
multiple enhancing parenchymal
lesion
Case no. 1
A lady 30yr was sent in the department of Radiology for CT scan of head
Case 1 contd. History
Severe headache for months Often Fits
Patient was treated in village by some
quacks. NO RESPONSE
Case 1……CECT Head
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CT scan finding
Most of the brain parenchyma
is riddled with numerous cysts
of varying size(1-10mm), with
dot calcificaion, few nodular
calcification & tiny hypodense
nonenhancing lesion
Diagnosis case no.1
NEURO-CYSTICERCOSIS
brain parenchyma is riddled with
cysts…..characteristic images with
all stages of evolution of parasite
Case no.2
A lady aged 40yr came in the
department of Radiology for
CT scan head
Case no.2 contd.History
Patient complained of-
Painful swollen eye Headache Gradual loss of vision
Clinical examination
On slit lamp exam two VIABLE MOBILE larva are
visualized in anterior chamber
of left eye
Plain CT scan brain……
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Ocular region…..
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CT scan finding
Few calcifications in posterior
ocular wall close to optic
nerve head both eye Few dot calcification with
minimal perilesional oedma
Diagnosis case no. 2
NEURO-OCULAR
CYSTICERCOSIS
In correlation with slit lamp
exam. anterior chamber
VIABLE PARASITE SEEN
Diagnosis depends on…
Clinical history Lab test (enzyme linked
immunotransfer blotting) Imaging finding
No diagnostic tests identify all cases of cysticercosis
Neuroimaging
Since the introduction of CT &
later MRI, vast majority of
single enhancing lesion until
then attributed to Tuberculosis
were in fact degenerating
CYSTICERCI