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Neurocysticercosis presenting as midbrain syndrome
1Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221 005.
The Journal of the Association of Physicians of India
|March 29, 2001
Summary
Neurocysticercosis rarely affects the brainstem, but two cases presented with acute midbrain syndrome due to large lesions. Diagnosis involved characteristic lesions and positive ELISA tests, with corticosteroid treatment showing limited long-term impact on lesion size.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Neurocysticercosis, a parasitic infection of the central nervous system, infrequently involves the brainstem.
- Brainstem involvement typically occurs with disseminated forms of the disease.
Observation:
- Two cases of neurocysticercosis presented with acute midbrain syndrome due to large, multiple cysticercus lesions.
- Diagnostic confirmation included characteristic granulomatous lesions in the midbrain and cerebral parenchyma.
- Strongly positive ELISA for cysticercal antigen in cerebrospinal fluid and serum supported the diagnosis.
Findings:
- Both patients showed initial improvement with corticosteroid therapy.
- Follow-up CT scans revealed no significant change in lesion size in one case, suggesting limited efficacy of corticosteroids in altering lesion size long-term.
Implications:
- This report highlights unusual brainstem presentations of neurocysticercosis.
- It underscores the importance of considering neurocysticercosis in cases of unexplained midbrain syndrome.
- The findings suggest that while corticosteroids may manage inflammation, they may not resolve the underlying parasitic lesions.