Neurocysticercosis: focus on intraventricular disease

Intraventricular neurocysticercosis is of concern because it is associated with a poorer prognosis than is parenchymatous disease. Frequently, associated hydrocephalus occurs, which may recur after treatment. We report on 11 patients with intraventricular cysticercosis (from a larger case series of 33 patients) and evaluate clinical presentations, neuroimaging findings, and responses to treatment, especially of ventricular disease. Intraventricular cysticercosis represented 33% of our cases. Seven patients presented with increased intracranial pressure; four required ventriculoperitoneal shunting. Parenchymatous symptomatic cysticercosis is largely a result of the host inflammatory response, presenting in our series with epileptic seizures in 73% of the patients (tonic clonic generalized seizures occurred in 64% and partial simple seizures in 9%). The prognosis for parenchymatous inflammatory disease is good. We advocate the use of anthelmintic treatment with albendazole in all cases of intraventricular cysts, and if hydrocephalus occurs, then shunt procedures or ventriculostomy is necessary. These patients must be monitored closely for recurrent hydrocephalus.