Clinical Diagnoses of Neurocysticercosis

Abstract

Neurocysticercosis (NCC), the most common parasitic brain disease worldwide, is endemic in countries with poor sanitation, and is increasingly being reported in developed countries due to globalization and immigration. As of many decades ago innumerable papers have been published regarding the clinical diagnosis of NC. It has been typical to affirm that clinical manifestations are extremely heterogeneous because they depend on the number, location, size, viability, or evolutionary phase of the parasite, as well as on the immunological response of the patient [1,2]. One of the most intriguing aspects of NCC is that presumably a high percentage of the individuals harboring NCC remain asymptomatic [3]; however, among the symptomatic group, the only clinical manifestation in most patients with parenchymal NCC is seizures, and their neurological status is usually normal [2]. In some patients NCC develops clinical manifestations many years after the parasite lodges in the central nervous system [4], as either brain inflammation around the parasite or mass effect. It has also been stated that almost any neurological symptomatology may be found, ranging from mild headache or treatable acute seizures to very severe neurological manifestations, such as intracranial hypertension (ICH), dementia, or even death [5-8]. These assumptions are probably true, since empirical observation has shown that many of these factors are related to a specific clinical manifestation; however, to date there is no definitive study, using appropriate methodology, designed to address the precise role of each of these factors, or the interaction among them, on the development of symptoms or signs due to NC. This is why the clinical spectrum of symptomatic NCC is currently poorly understood [9].