common problem in tropics,most common cause of seizure in tropical countries.

1. -

2.  24 year old gentle man from Dharan
presented with
 Jerky movement of all limbs:4 hours

3.  Seizure Disorder
 Metabolic disorder
 Neurocystecercosis
 Alcohol withdrawl
 Metastatic malignancy

7. Generalised Tonic Clonic Seizure Secondary
to Neurocysticercosis

9.  Introduction
 Epidemiology
. Life cycle
 Transmission
 Clinical features
 Diagnostic modalities of neurocysticercosis
 Treatment of neurocysticercosis
 Follow up
 Prevention

11.  Taenia solium has a predilection for skeletal
muscles, eyes, and the nervous system
 Two distinct types of infection
 IntestinalTaeniasis
 Cysticercosis

12. PARENCHYMAL
 Seizures – may be generalized, focal
 Pyramidal tract signs
 Sensory deficit
 Involuntary movement
 Brainstem dysfunction
 Intellectual deterioration

13. SUBARACHNOID
 Headache
 Vomiting
 Vertigo
 Cranial Nerve dysfunction
 Gait disturbances
 Mental deterioration

14. INTRAVENTRICULAR
 Subacute or intermittent intracranial
hypertension
 Sudden death with acute hydrocephalus
 BRUNS SYNDROME – Transient LOC due to
sudden interruption of CSF flow related to
movement of head

15.  CLINICAL (SOTELO & CARPIO)
Active
Transitional
Inactive
 PATHOLOGICAL (ESCOBAR)
Vesicular
Colloidal vesicular
Granular nodular
Nodular calcified
Case report: the value of MRI in diagnosis of neurocysticercosis,
Singapore medical journal 2000; Vol 41 (3): 132 – 134

16. Vesicular stage
minimal inflammatory response
Parasites look healthy
clear vesicular fluid with a visible scolex
Colloidal stage
inflammation, mononuclear cells
vesicular fluid becomes turbid
scolex shows early signs of degeneration
Granular nodular stage
gradual replacement by fibrotic tissue
collapse of cell wall
Calcific stage
replacement of the wall with calcium

17.  Neuroimaging – mainstay of diagnosis
 Lesions suggestive of NCC on CT, with
compatible clinical picture in endemic areas
are usually diagnosed as NCC

18. Neurocysticercosis
Tuberculoma
Brain abscess – fungal as well as pyogenic
Fungal granuloma
Toxoplasmosis
Infectious vasculitis
Primary malignancy in brain
Secondary metastasis to brain

19.  Cysticerci
 usually round in shape
 20 mm or less in size with ring enhancement or visible scolex
 Cerebral edema severe enough to produce midline shift
 No Focal neurological deficit
 Tuberculomas
 usually irregular
 Solid and greater than 20 mm in size
 Severe perifocal edema
 Focal neurological deficit
*

20.  Depend on –
-Site
- Stage of neurocystecercosis
- Number of lesion
- Location
- Presentation

21.  Medical:
a) Cysticidal
 Albendazole, Praziquantel
b) Steroid
 Dexamethasone, Prednisolone
c) Anti-epeleptics
- Phenytoin, Carbamazepine
 Surigical
a) Endoscopic removal
b) Shunting surgery
c) Local excision

22.  Albendazole
 Imidazole group
 acts by inhibiting the uptake of glucose by parasitic membranes thus
causing energy depletion
 15 mg/kg/day in 2 divided doses
 Praziquantel
 Isoquinolone group
 spastic paralysis of the parasite musculature and destroys the scolex
 50- 100 mg/kg /day in 3 divided dose

23.  Corticosteroids are an adjunct to cysticidal therapy
 High dose corticosteroids are the primary therapy
for cysticercotic encephalitis
 In case of subarachnoid cyst, chronic meningitic
form or in case of multiple viable cysts steroids
should be given along with cysticidal drugs

24.  The antiepileptic drugs are no different in
NCC than in other seizure disorder
 Single first line antiepileptic drugs like
phenytoin, carbamazepine result in adequate
control of seizures
 The optimal length of antiepileptic drug
therapy in patients with NCC has been a
subject of debate