Neurocysticercosis is the most common helminthic infection of the CNS but its diagnosis remains difficult. Clinical manifestations are nonspecific, most neuroimaging findings are not pathognomonic, and some serologic tests have low sensitivity and specificity.
Diagnostic Criteria for Neurocysticercosis
Absolute
· Histologic demonstration of the parasite from biopsy of a brain or spinal cord lesion
· Cystic lesions showing the scolex on CT or MRI
· Direct visualization of subretinal parasites by fundoscopic examination
Major
· Lesions highly suggestive of neurocysticercosis on neuroimaging studies
· Positive serum immunoblot for the detection of anticysticercal antibodies
· Resolution of intracranial cystic lesions after therapy with albendazole or praziquantel
· Spontaneous resolution of small single enhancing lesions
Minor
· Lesions compatible with neurocysticercosis on neuroimaging studies
· Clinical manifestations suggestive of neurocysticercosis
· Positive CSF ELISA for detection of anticysticercal antibodies or cysticercal antigens
· Cysticercosis outside the central nervous system
Epidemiologic
· Evidence of a household contact with T. solium infection
· Individuals coming from or living in an area where cysticercosis is endemic
· History of frequent travel to disease-endemic areas
CSF, cerebrospinal fluid; ELISA, enzyme-linked immunosorbent assay.
References:
- Del Brutto OH, Rajshekhar V, White Jr AC, Tsang VCW, Nash TE, Takayanagui OM, et al. Proposed diagnostic criteria for neurocysticercosis. Neurology 2001; 57: 177-83. [Medline]
- Garcia HH, Evans CA, Nash TE, Takayanagui OM, White AC Jr, Botero D, Rajshekhar V, Tsang VC, Schantz PM, Allan JC, Flisser A, Correa D, Sarti E, Friedland JS, Martinez SM, Gonzalez AE, Gilman RH, Del Brutto OH.Current consensus guidelines for treatment of neurocysticercosis. Clin Microbiol Rev. 2002 Oct;15(4):747-56. [Medline]
Created: Sep 08, 2005
