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Year : 2010  |  Volume : 58  |  Issue : 5  |  Page : 814--815

An unusual cause of entrapment of temporal horn: Neurocysticercosis

Sunil K Singh1, Chhitij Srivastava1, BK Ojha1, Anil Chandra1, Anit Parihar2, Nuzhat Husain3,  
1 Department of Neurosurgery, CSM Medical University, Lucknow - 226 003, India
2 Department of Radio-diagnosis, CSM Medical University, Lucknow - 226 003, India
3 Department of Pathology, CSM Medical University, Lucknow - 226 003, India

Correspondence Address:
Sunil K Singh
Department of Neurosurgery, CSM Medical University, Lucknow - 226 003

How to cite this article:
Singh SK, Srivastava C, Ojha B K, Chandra A, Parihar A, Husain N. An unusual cause of entrapment of temporal horn: Neurocysticercosis.Neurol India 2010;58:814-815

How to cite this URL:
Singh SK, Srivastava C, Ojha B K, Chandra A, Parihar A, Husain N. An unusual cause of entrapment of temporal horn: Neurocysticercosis. Neurol India [serial online] 2010 [cited 2022 May 20 ];58:814-815
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Full Text


Entrapment of temporal horn is a rare entity caused by obstruction at the trigone of the lateral ventricle, which seals off the temporal horn from the rest of the ventricular system. [1] Intraventricular cysticercosis accounts for 7% to 30% of NCC [2] and it causing an entrapped temporal horn has not been reported till date. We are reporting two interesting cases of entrapped temporal horn syndrome caused by giant intraventricular cysticercosis.

Case 1: A 35-year-old woman presented with a 4-day history of headache and vomiting. Computerized tomography (CT) scan showed a large right temporal cystic lesion with a few intra-cystic and parenchymal micro calcifications. Contrast magnetic resonance imaging (MRI) showed multiple large cysts in the right temporal horn. Patient was taken up for surgery and the temporal horn was approached endoscopically. Multiple cysts were removed and a stoma was made to connect with the ipsilateral atrium; but later, shunt surgery was required. There were no further complications during 1-year of follow-up.

Case 2: A 35-year-old woman presented with two months history of headache and left-sided focal seizures. On examination, the Glasgow coma scale score was E3V3M5. Contrast CT scan brain showed a non-enhancing right temporal cystic mass. Contrast MRI showed a huge 6-cm T1 hypointense and T2 hyperintense lesion. The patient was taken up for emergency surgery. The cyst was aspirated, yielding a lightly viscous straw-colored fluid. The lesion was approached through a trans-sulcal route until a well-defined whitish translucent cyst wall was encountered. The fluid earlier aspirated was actually from the entrapped horn as the cyst itself contained only clear fluid. The cyst was removed in toto without rupture and was found to contain multiple similar small cysts inside it measuring about 5 cm in diameter.

Microscopically the typical cysticercus cyst wall was seen in both the cases. The lesion showed areas of degeneration, including the scolex. The large cysts also contained multiple daughter cysts [Figure 1]. On follow-up CT scans, the size of the temporal horn had significantly reduced in both patients [Figure 2] Entrapment of the temporal horn is the term first used by Maurice-Williams et al. to describe a form of focal hydrocephalus. Temporal horn contains choroid plexus, and the cerebrospinal fluid secreted results in the temporal horn expansion into a cyst. This results in symptoms of raised intracranial pressure and focal deficits. [3] Causes of entrapped temporal horn include tuberculous choroids plexitis, streptococcal choroid plexitis, hydatid cyst, recurrent glioma, postsurgical removal of arterio venous malformation, pseudomonas, neurosarcoidosis, histiocytosis and cryptococcal meningoencephalitis. [3] {Figure 1}{Figure 2}

Probably these two patients are the first documented cases of entrapped temporal horn caused by a giant neurocysticercus. Neurocysticerci undergo four stages of involution: vesicular, colloidal, granulovacuvolar and calcific. This evolution does not occur in the intraventricular or the subarachnoid forms (or racemose type) of NCC. [4] Degenerating cyst can elicit a widespread ependymitis. However, this pathological process has never been known to cause entrapment of a part of the ventricular system.

The treatment of IV NCC is symptom specific. Antihelminthic medication, albendazole or praziquantel, hastens the evolution of intraventricular viable cysts, which may trigger an inflammatory response similar to that seen with the natural history of the parasite. This may result in long-term sequelae. It is a common practice to ascribe entrapment of the temporal horn to tubercular meningitis in developing countries and treat empirically by shunting and anti-tubercular therapy. However, this previously unknown cause of the entrapped horn, NCC must be kept in mind, especially in the developing world whenever planning shunting of an entrapped temporal horn as the primary therapy. An enhanced MRI scan should be done to exclude other causes especially cysticercosis.


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