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Images in Neurology
June 2011

A Dramatic Case of Intraventricular Cysticercosis

Author Affiliations

Author Affiliations: Instituto Nacional de Neurología y Neurocirugía (Drs Cárdenas, Bahena, Soto-Hernandez, and Fleury) and Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Departamento de Inmunología (Dr Fleury), Mexico City, Mexico.

Arch Neurol. 2011;68(6):828-829. doi:10.1001/archneurol.2011.122

A previously healthy, 77-year-old man was admitted to the Instituto Nacional de Neurología y Neurocirugía reporting 4 months of increasing headache. Hydrocephalus and vesicular cysticerci in the subarachnoid space were diagnosed. A cerebrospinal fluid shunt was placed, and albendazole plus corticosteroids were administered. The patient did not attend follow-up appointments and returned 2 years later with hydrocephalus and subarachnoid parasites. A new cerebrospinal fluid shunt was placed and he received a second cycle of albendazole plus corticosteroids. Clinical improvement was observed; however, 6 months later magnetic resonance imaging showed new parasites now localized in the ventricular system (Figure, A). A third cycle of albendazole plus corticosteroids was administered. Magnetic resonance imaging performed 6 months later showed persistence of ventricular parasites (Figure, B). Neuroendoscopic surgery was planned but since the patient had difficulties getting to the hospital, the surgery was performed 8 months later. Magnetic resonance imaging performed just before the surgery showed an increase in the ventricular parasite burden (Figure, C and D). More than 40 parasites were removed and a new cycle of albendazole plus corticosteroids was then administered. There was no clinical improvement and the patient died 1 month later.

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