Cerebrospinal fluid cytology in five patients with cerebral cysticercosis

Cerebral cysticercosis from Taenia solium infection is a common disease in Central American countries but an infrequent one in the United States. We report distinctive cellular findings in cerebrospinal fluid (CSF) and attendant clinical features in five patients from Central America. The patients' histories showed variable previous parasitic infestations; their neurologic symptoms and signs usually were nonfocal. Routine examination of CSF of the five patients revealed elevated leukocyte counts, but eosinophilia was found in only two. Three of the CSFs showed marked pleocytosis, high variability and atypia, indicating possible lymphoma of the central nervous system. No hooklets or other structures associated with parasitic invasion were identified. The clinical findings, together with the cellular pleomorphism in CSF, generally suggested an inflammatory lesion rather than lymphoma. In cerebral cysticercosis, confirmation of diagnosis requires proof of the etiologic agent.