Cerebral cysticercosis in children in South Africa

Sixty-one children with cerebral cysticercosis are presented. The commonest clinical manifestation was epilepsy with or without focal signs in 43% of children, followed by the syndrome of raised intracranial pressure in 34% and meningoencephalitis in 13%. The CT scan was positive in 93% of cases and the HAI test in 86% of children so examined. Both were positive in 80%. Skull X-ray revealed evidence of calcification and/or raised intracranial pressure in 60%. Two children died, one each with subacute sclerosing panencephalitis and tuberculous meningitis. Of those who improved on discharge, 43% had epilepsy and 32% neurological deficit of an obvious nature. The parasitology, pathogenesis, pathology and diagnosis of cerebral cysticercosis are briefly reviewed. Present therapy and the suggested use of a specific anti-cysticeral drug are discussed. Case histories are presented to draw attention to the variability of the clinical picture and the particular importance of recognising the acute parenchymatous form of the disease in children which may present with critically elevated intracranial pressure.