Revised Diagnostic Criteria for Neurocysticercosis

This simplified revised set of diagnostic criteria may facilitate its more uniform and widespread applicability in different clinical scenarios and environments. 

Revised diagnostic criteria and degrees of diagnostic certainty for neurocysticercosis.

Absolute criteria:
• Histological demonstration of the parasite from biopsy of a brain or spinal cord lesion.
• Visualization of subretinal cysticercus.
• Conclusive demonstration of a scolex within a cystic lesion on neuroimaging studies.

Neuroimaging criteria:
Major neuroimaging criteria:
• Cystic lesions without a discernible scolex.
• Enhancing lesions.*
• Multilobulated cystic lesions in the subarachnoid space.
• Typical parenchymal brain calcifications.*
Confirmative neuroimaging criteria:
• Resolution of cystic lesions after cysticidal drug therapy.
• Spontaneous resolution of single small enhancing lesions.**
• Migration of ventricular cysts documented on sequential neuroimaging studies.*
Minor neuroimaging criteria:
• Obstructive hydrocephalus (symmetric or asymmetric) or abnormal enhancement
of basal leptomeninges.

Clinical/exposure criteria:
Major clinical/exposure:
• Detection of specific anticysticercal antibodies or cysticercal antigens by well–
standardized immunodiagnostic tests.*
• Cysticercosis outside the central nervous system.*
• Evidence of a household contact with T. solium infection.
Minor clinical/exposure:
• Clinical manifestations suggestive of neurocysticercosis.*
• Individuals coming from or living in an area where cysticercosis is endemic.*
Degrees of diagnostic certainty

Definitive diagnosis:
• One absolute criterion.
• Two major neuroimaging criteria plus any clinical/exposure criteria.
• One major and one confirmative neuroimaging criteria plus any clinical/-
exposure criteria.
• One major neuroimaging criteria plus two clinical/exposure criteria (including
at least one major clinical/exposure criterion), together with the exclusion of
other pathologies producing similar neuroimaging findings.
Probable diagnosis:
• One major neuroimaging criteria plus any two clinical/exposure criteria.
• One minor neuroimaging criteria plus at least one major clinical/exposure
criteria.

* Operational definitions. Cystic lesions: rounded, well defined lesions with liquid contents of signal similar to that of CSF on CT or MRI; enhancing lesions: single or multiple, ring- or nodular-enhancing lesions of 10–20 mm in diameter, with or without surrounding edema, but not displacing midline structures; typical parenchymal brain calcifications: single or multiple, solid, and most usually <10 mm in diameter; migration of ventricular cyst: demonstration of a different location of ventricular cystic lesions on sequential CTs or MRIs; well-standardized immunodiagnostic tests: so far, antibody detection by enzymelinked immunoelectrotransfer blot (EITB) assay using lentil lectin-purified T. solium antigens, and detection of cysticercal antigens by monoclonal antibody-based ELISA; cysticercosis outside the central nervous system: demonstration of cysticerci from biopsy of subcutaneous nodules, X-ray films or CT showing cigar-shape calcifications in soft tissues, or visualization of the parasite in the anterior chamber of the eye; suggestive clinical manifestations: mainly seizures (often starting in individuals aged 20–49 years; the diagnosis of seizures in this context is not excluded if patients are outside of the typical age range), but other manifestations include chronic headaches, focal neurologic deficits, intracranial hypertension and cognitive decline; cysticercosis-endemic area: a place where active transmission is documented.
** The use of corticosteroids makes this criterion invalid

 

References:

  1. Del Brutto OH, Nash TE, White AC Jr, Rajshekhar V, Wilkins PP, Singh G, Vasquez CM, Salgado P, Gilman RH, Garcia HH. Revised diagnostic criteria for neurocysticercosis. J Neurol Sci. 2017 Jan 15;372:202-210. [Medline]
  2. Bustos JA, García HH, Del Brutto OH. Reliability of Diagnostic Criteria for Neurocysticercosis for Patients with Ventricular Cystic Lesions or Granulomas: A systematic review. Am J Trop Med Hyg. 2017 Sep;97(3):653-657. [Medline]

Created Mar 22, 2018.

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