Neurocysticercosis: Acute presentation and intensive care management of two cases

Neurocysticercosis (NCC), a common helminthic infestation in developing countries, may cause acquired epilepsy and neurological morbidities. Acute symptomatic seizure is the most common manifestation. The other clinical conditions include headache, hydrocephalus, chronic meningitis, focal neurological deficits, and psychological disorders. Altered sensorium and raised intracranial pressure (ICP) may require ventilatory support in an intensive care unit (ICU). Definitive diagnosis is made by identification of parasites in tissues or by a radiological demonstration of the scolex in cystic lesions. Antiepileptic drugs are used to control seizures after NCC. Steroids are generally administered along with antihelminthics, in order to control the edema and intracranial hypertension that may occur as a result of antiparasitic medications. In patients with intracranial hypertension, the priority is to manage the ICP before considering other treatment options. Antiparasitic drug treatment is never the mainstay of treatment, especially in the setting of elevated ICP. Here, we present the ICU management of two such cases.