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NEUROIMAGES
Year : 2019  |  Volume : 67  |  Issue : 3  |  Page : 929-930

Persistent encephalopathy in a patient with numerous neurocysticerci


Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India

Date of Web Publication23-Jul-2019

Correspondence Address:
Dr. Ravindra K Garg
Department of Neurology, King George Medical University, Lucknow - 226 003, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.263228

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How to cite this article:
Garg RK, Pandey S, Rizvi I, Uniyal R, Malhotra HS, Kumar N. Persistent encephalopathy in a patient with numerous neurocysticerci. Neurol India 2019;67:929-30

How to cite this URL:
Garg RK, Pandey S, Rizvi I, Uniyal R, Malhotra HS, Kumar N. Persistent encephalopathy in a patient with numerous neurocysticerci. Neurol India [serial online] 2019 [cited 2019 Aug 24];67:929-30. Available from: http://www.neurologyindia.com/text.asp?2019/67/3/929/263228




The history of this patient dates back to October 2016, when he had multiple episodes of generalized tonic clonic seizures and headache. The patient was admitted elsewhere in the state of altered sensorium. Magnetic resonance imaging (MRI) of the brain revealed numerous cysticercal lesions [Figure 1]. The patient was treated with albendazole along with corticosteroids and antiepileptics. While the seizures stopped, consciousness of the patient improved; meaningful communication, however, was impaired. In May 2018, the patient presented to us with multiple episodes of seizures, headache, and encephalopathy. The patient was drowsy most of the time and had to be fed. Spontaneous speech and verbal communication were poor. He was incontinent. He was able to walk when aroused. Plantars were bilaterally extensor. MRI of the brain showed a significant reduction in the lesion load. In addition, diffuse pachymeningeal enhancement, similar to that evident in intracranial hypotension or subdural effusion, was noted [Figure 1]. The patient was treated with oral prednisolone and antiepieptic drugs. After 6 weeks, the patient was marginally better. The parents noticed that the patient was comparatively more responsive.
Figure 1: The first four images (A-D in yellow). T2-weighted axial and sagittal (A and C), FLAIR (B), and gadolinium contrast (D) images show “too numerous to count” neurocysticerci. The next set of four images (A-D in white). T2-weighted axial and sagittal (A and C), FLAIR (B), and gadolinium contrast (D) images show a marked lesion reduction along with pachymeningeal enhancement (red arrows)

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A subset of patients, usually children, with a heavy load of cerebral neurocysticercosis land into a devastating encephalopathy.[1] Treatment with albendazole and praziquantel is considered hazardous in such patients. A series of 144 patients with rapidly progressive cognitive decline reported that approximately 43% of patients had neurocysticercosis.[2] Precise reasons of occurrence of encephalopathy in patients with massive neurocysticercosis are not known; a genetic factor is likely.[3],[4],[5]

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  References Top

1.
Sharawat IK, Padmanabha H, Suthar R, Vyas S, Sankhyan N. Recurrent encephalopathy in milliary neurocysticercosis: An uncommon manifestation of a common infection. J Infect Public Health 2018;11:893-5.  Back to cited text no. 1
    
2.
Chandra SR, Viswanathan LG, Pai AR, Wahatule R, Alladi S. Syndromes of rapidly progressive cognitive decline-our experience. J Neurosci Rural Pract 2017;8(Suppl 1):S66-71.  Back to cited text no. 2
    
3.
Qavi A, Garg RK, Malhotra HS, Jain A, Kumar N, Malhotra KP, et al. Disseminated cysticercosis: Clinical spectrum, Toll-like receptor-4 gene polymorphisms and role of albendazole. Medicine (Baltimore) 2016;95:e4882.  Back to cited text no. 3
    
4.
Rajshekhar V. Evolution of concepts in the management of cysticercosis of the brain: Then (1970) and now (2018). Neurol India 2018;66:919-27  Back to cited text no. 4
    
5.
Muthukumar N. Neurocysticercosis: Evolution of our understanding. Neurol India 2017;65:885-7  Back to cited text no. 5
    


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