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  In this Article
 »  Abstract
 »  Introduction
 »  Case report
 »  Result
 »  References

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Year : 2001  |  Volume : 49  |  Issue : 2  |  Page : 206-8

Cisternal cysticercosis : a diagnostic problem--a short report.


Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, 632 004, India.

Correspondence Address:
Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, 632 004, India.

  »  Abstract

We describe a patient in whom a hypodense nonenhancing mass on CT scan in the regions of quadrigeminal cistern, and causing obstructive hydrocephalus, was initially diagnosed as an epidermoid but subsequent MR evaluation and surgery resulted in the diagnosis of a racemose cysticercus cyst.

How to cite this article:
Bannur U, Rajshekhar V. Cisternal cysticercosis : a diagnostic problem--a short report. Neurol India 2001;49:206


How to cite this URL:
Bannur U, Rajshekhar V. Cisternal cysticercosis : a diagnostic problem--a short report. Neurol India [serial online] 2001 [cited 2021 Jun 17];49:206. Available from: https://www.neurologyindia.com/text.asp?2001/49/2/206/1259




   »   Introduction Top

The report highlights the difficulties that might be encountered in the diagnosis of a cysticercus cyst occupying the subarachnoid spaces.


   »   Case report Top

A 17 year old girl presented with intermittent headache and vomiting of one and a half years duration. On examination, she had bilateral papilloedema with no focal neurological deficit. Plain and contrast CT scan showed a non-enhancing hypodense lesion in the quadrigeminal and ambient cistern with widening of these cisterns and dilated lateral and third ventricles [Figure 1A]. The possibility of an epidermoid cyst was considered. She underwent a right ventriculo-peritoneal shunt with total relief of her symptoms. She was asked to come a few months later for definitive surgery of the tumour. However, she recruited new neurological symptoms within 3 months and presented to us 5 months after her surgery with diplopia, upgaze paresis, bifacial weakness, dysphonia and dysphagia along with bipyramidal signs. A MRI scan (0. 5T) done at this time showed that the mass, which had increased in size, was multiloculated, occupied the quadrigeminal and ambient cisterns. It was of CSF intensity, homogenously hypointense on T1WI, hyperintense on T2 weighted images, showing minimal enhancement at the periphery following gadolinium injection [Figure 1B] and [Figure 1C]. A diagnosis of intracisternal cysticerci with basal arachnoiditis was made.

She underwent midline sub-occipital craniectomy and a supracerebellar approach for biopsy of the lesion in the quadrigeminal cistern. Intra-operatively, there were dense adhesions between the tentorium and the cerebellum. The arachnoid of the quadrigeminal and superior cerebellar cisterns was thick and milky white. There was a large cyst in the quadrigeminal cistern on the left side which was removed. Intra-operative impression was that of racemose type of cysticercus cyst, which was confirmed on histopathology [Figure - 2]. Post-operatively, she was treated with a course of albendazole for 3 weeks along with steroids. Though there was no further progression, she did not show any improvement in her neurological status at the time of discharge a week later and during subsequent followup every month, over the next 6 months.
Parenchymal form of neurocysticercosis (NCC) more often have a tumoural form of presentation than cisternal cysticeri.[1] However, cisternal cysticerci in their racemose form, can form mass lesions in the basal cisterns. They can also produce basal arachnoiditis causing communicating or obstructive hydrocephalus, cranial neuropathies and vasculitis.[2],[3] Cysticercus cysts which lodge in the subarachnoid cisterns are transformed into racemose cysts which are multilobular, non-viable cysts.[4] Many of these cysts do not have a scolex.[5] Another feature of cisternal cysticercus cysts is their mobility, which is best demonstrated on metrizamide ventriculogram.[6] Though MRI has been shown to be the best investigations for identifying cisternal cysticercus lesions,[6],[7] it is difficult to differentiate them from other non-enhancing lesions like epidermoid or arachnoid cysts. At times, it is only possible to distinguish between these entities by studying the evolution of the lesion on an image, as seen in our case. As MR imaging may not always provide a definitive diagnosis of cisternal cysticerci,[10] a high index of suspicion and clinical and imaging follow-up might be needed to arrive at a diagnosis. Histological confirmation following surgical exploration may still be needed in some cases.
 

  »   References Top

1.Ramina R, Hunhevicz SC : Cerebral cysticercosis presenting as a mass lesion. Surg Neurol. 1986; 25 : 89-93.   Back to cited text no. 1    
2.Latovitski N, Abrams G, Clark C et al : Cerebral cysticercus. Neurology1978; 28 : 838-842.   Back to cited text no. 2    
3.Shanley JD, Jordan MC : Clinical aspects of CNS cysticercosis. Arch Internal Med 1980; 140 : 1309-1313.   Back to cited text no. 3    
4.Percy AK, Byrd SE, Locke GE : Cerebral cysticercosis. Paediatrics 1980; 66 : 967-971.   Back to cited text no. 4    
5.Couldwell WT, Zee CS, Apuzzo MLJ : Definition of the role of contemporary surgical management in cisternal and parenchymatous cysticercosis cerebri. Neurosurgery 1991; 28 : 231-238.   Back to cited text no. 5    
6.Higashi K, Yamagami T, Satoh G et al : Cerebral cysticercosis: A case report. Surg Neurol 1993; 39 : 474478.   Back to cited text no. 6    
7.Martinez HR, Guerra PR, ELizaondo G : MR imaging in neurocysticercosis. AJNR 1989; 10 : 1011-1019.   Back to cited text no. 7    
8.Singh S, Gibikote SV, Bannur U et al : Cysticercosis of the cerebellopontine angle cistern mimicking epidermoid inclusion cyst. Acta Neurol Scand 1999; 98 : 1-4.   Back to cited text no. 8    

 

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