Neurocysticercosis in the United States: 35 cases and a review

Neurocysticercosis has become more prominent in the United States in recent years because of an increase in immigration from endemic regions and because of improved ease of diagnosis with computed tomography (CT). Neurocysticercosis should be suspected in any patient from a high-risk region who has symptoms or signs of a central nervous system disorder, especially seizures, headaches, or signs of increased intracranial pressure. The best diagnostic test is CT of the head, which usually shows a combination of multiple punctate calcifications; hydrocephalus; and parenchymal, subarachnoid, or intraventricular cysts with and without contrast enhancement. Cysticercosis is confirmed serologically by measurement of cysticercosis antibody titers in serum or cerebrospinal fluid and histologically by biopsy of a lesion. Treatment with praziquantel and dexamethasone is usually sufficient, but ventricular shunting or surgical removal of intraventricular or spinal cysts may be necessary. Whenever a case is identified, other household members should be examined for symptoms and signs of neurocysticercosis and screened for active Taenia solium infection.