Diagnosis, Treatments, Clinical Outlook, and Summary

Diagnosis

Diagnosis of both cysticercosis, and neurocysticercosis often begins with nonspecific symptoms that seem to arise randomly and from no cause.  Common symptoms such as recurring headaches and confusion, as well as nausea can be symptomatic of many different conditions.  If there is no history of travel to endemic areas, parasitic infection isn't an easy diagnosis to make.  More helpful for diagnosis, "focal neurologic deficits and symptoms of a mass may also be present" (3).  A variety of methods can be used to come to diagnosis, the common ones being bioposy, radiography, and computer tomography.

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Magnetic Resonance Imaging (MRI) can also be used to image and identify possible cysts.  The image to the left shows the differences between a brain filled with cysts on the bottom, and a healthy brain on the top.  Tissue dysfunction and disorganization are inevitable with neurocysticercosis infection.  Any patient history of travel to endemic areas is also a diagnostic tool (16).  Immunologic tests such as the ELISA test can be used to test for antibodies against the cyst, but if an individual does not have many cysts, or previous exposure to the tapeworm infection, this test is less helpful.  Antigen detection is most helpful in differentiating a cysticercosis infection or a taeniasis infection.  Taeniasis is infection with the adult stage tapeworm.  Neurocysticercosis can be clinically diagnosed using neuroimaging and patient history due to the difficulty of getting cyst tissue.  Imaging techniques search for abnormalitites, and cerebrospinal fluid (CSF) may be analyzed for increased numbers of eosinophils, which are present in increased numbers during parasite infections.  If tissue is available for biopsy, the cysts are usually smooth, oval shaped, 1 to 2 cm, and contain a whitish fluid (3).

Therapies/Treatments

A brain infected with neurocysticercosis.
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Treatment of cysticercosis, and neurocysticercosis depends on the location of the cyst or cysts, and the symptoms they are causing.  In some situations, treatment is not needed.  In the muscle tissue, a single cyst will not generally cause any pain or alter a person's quality of life (1).  Treatment in those situations would be more of a detriment to the patient than a help.  In some cases of neurocysticercosis, the cyst can be causing any number of symptoms such as seizures or hydrocephaly, and would require removal in order to regain patient quality of life.  Surgical options are available depending on cyst location.  "Antiparasitic medications are generally effective but there have been rare treatment-related deaths (1%-4%) in cases with hydrocephalus, and massive parasitic loads" (3).


Clinical Outlook

Prognosis is conditional upon the location and number of cysts within the body.  In the case of cysticercosis, the prognosis is generally very positive due to either ease of removal or a lack of symptoms necessitating removal.  The prognosis of an individual with neurocysticercosis is highly dependent on the location of the cyst within the brain, the amount of cysts within the brain, and the toll they are taking on the surrounding tissues (3).  Patients with hydrocephalus due to the presence of the cyst or cysts, have a worse prognosis due to the damage done by increased cranial pressure.  Seizure prevalence, however, will decrease with the death of or removal of the cyst.  Overall, clinical outlook is highly dependent on cyst location and number, but in general, patients experience an increase in quality of life after treatment and removal of the cyst.

Summary

Cysticercosis in its neurologic form is an incredibly easy infection to prevent.  Simple hand and food hygiene can prevent the infection of tapeworm larvae in any body tissues, but especially the brain.  Once a cyst has migrated to the brain, the symptom severity and infection severity both increase.  This highly preventable condition infects a surprisingly high amount of people every year, over 50 million (5).  Cysticercosis is a simple condition to recover from, leaving little to no lasting effects in the body tissues or symptoms.  Neurocysticercosis can result in lasting brain damage depending on the location and amount of cysts in the body.  Hydrocephaly as one example, is a result of cyst/cysts blocking the movement of CSF, and can result in irreversible brain damage.  However with increasing pressure towards patient and personal education from the CDC, this condition can be easily avoided, and even prevented altogether.  Hand and food hygiene is the best and most effective method of preventing cysticercosis, and its neurologic form, neurocysticercosis.

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