II.

PATHOPHYSIOLOGY OF NEUROCYSTICERCOSIS

Definition: It is a parasitic infection in the central nervous system that is caused by a tapeworm called Taenia solium (T. solium).

Schematic Diagram:

Predisposing Factors: Precipitating Factors:

>Race: Hispanics ethnicity >Exposure to areas of
>Age: Children older than 7 endemicity
years old >Poor sanitation
>Geographical area: Latin >Poor hygiene
America, Asia, Africa, Spain, and >Use of sewage for fertilizer
Eastern Europe. California and >Lack of controlled pens for
Texas and in the city of Chicago pigs
>Immigrant status from Mexico, >Ingestion of undercook pork
Central and South America meats
>Family history of taeniasis >Sharing of food from the
same plate

Ingestion of Tapeworm larvae

with undercooked pork

Worm attaches to the intestinal wall by means

of suckers and hooks and it develops in the
small intestine by forming segments
(hermaphrodite proglottids containing more
than 50,000 eggs) that arise from the caudal
end of the scolex. The tapeworm matures over
3-4 months after infection, acheiving a length
Diagnostic:
Fecalysis:
The eggs are intermittently
Parasites:
Opaque, off-white pushed out from the proglottid
in color, 1-2 cm into the intestine and
long, 1 cm wide proglottids may be shed in the
and 2-3 mm thick. feces 2 or 3 times a week.

Ingestion of food containing eggs that are

transferred from anus to mouth by unclean hands
of an infected person

When these eggs are ingested and exposed to gastric acid in the
human stomach, they lose their protective capsule and release a cyst
form called oncosphere (the larva of the tapeworm armed with 4
hooks) and becomes active in the intestinal wall.

The larval cysts penetrate and erodes the intestinal mucosa and
migrate throughout the body via the vascular system to the brain,
muscle, eyes and other structures and lives in tissues as fluid-filled
cysts (metacestodes).

Human Cysticercosis

The larval cysts lodge to the different parts of

the brain with varying macroscopic
appearance of cysticerci
Brain parenchyma: Viable
cysticerci measure
approximately 10 mm tends
to lodge in the cerebral
cortex or the basal ganglia
because of the high vascular
supply in these areas
Subarachnoid space: Ventricular area: Viable
Viable cysticerci tends to cysts are usually single
lodge within cortical sulci or lesions, that lodge to the
in the CSF (Cerebrospinal choroid plexus or float freely
Fluid) cisterns at the base of within the ventricular cavities
the brain and grow to reach
50mm or more because their
growth is not limited by the
effect of pressure

MRI scan,
Neurocysticerco
CT scan
sis
After entering the CNS, cysticerci are viable and induce slight
inflammatory changes in the surrounding tissues. Minimum inflammatory Sudden
reaction around the cyst because the parasite carry out prostaglandins Headache
and low molecular wieght molecules which decrease perilesional
inflammation and secrete proteases that can degrade interleukin 2 and
immunoglobulin Management:
Corticosteroids
The parasite remains alive and undergo different stages such as vesicular
stage, colloidal stage, granular nodular stage, and nodular calcified

Vesicular stage: parasites have a transparent membrane, clear vesicular

fluid, and larva or scolex and may remain for decades (asymptomatic).

As the result of a complex immunological attack from the host by

releasing lymphocyte proliferation and macrophages, cytokines, T cells
and antibodies, the cysticerci enters into a process of degeneration that
 Colloidal stage: parasite dies within 4-5 years untreated, or earlier Mrdical management:
with treatment and the cyst fluid becomes turbid. As the membrane >Antihelminthics:
becomes leaky edema surrounds the cyst. Albendazole,
praziquantel

>surgical removal of
Granular stage: the wall of the cyst thickens and scolex is the cyst via endoscopy
transformed into coarse mineralized granules.

Calcified stage: the parasite remnants appear as a mineralized nodule

.
Signs &
Symptoms:
Diagnostic tests: Intense inflammation by the cysticerci in the subarachnoid space or in the
Sudden or
>CSF analysis: ventricular areas in the brain with formation of a dense exudate composed severe
mild pleocytosis of collagen fibers, lymphocytes, plasma cells, eosinophils, multinucleated Headache,
and elevated giant cells, and hyalinized parasitic membranes leading to leptomeningeal fever
protein contents
thickening. It is called cysticercotic arachnoiditis.
>ELISA and
complement Management:
fixation test: Occlusion by the thickened leptomeninges in the subarachnoid area or Corticosteroids
positive of in ventricular area especially in the choroid plexus and ventricular wall.
anticysticercal
antibodies

Secretion of the CSF (cerebrospinal fluid) continues even if the flow of

fluid through the ventricular system is blocked

Headaches,
vomiting, nausea,
papilledema,
sleepiness, coma,
seizures(tonic-clonic
or simple partial or
complex partial
Surdical
Excessive accumulation of CSF procedure:
within the ventricular spaces of Ventricular
the brain leading to a non- shunt
communiting hydrocephalus
 MRI scan,
CT scan,
EEG
Compression and atrophy of the Small penetrating arteries arising
brain tissues around the dilated from the circle of Willis are also
ocular palsies, ventricles. affected by this inflammatory
altered level of reaction
consciousness, back
Increased intracranial pressure
pain
develops Occlusion of the lumen of the
and papilledema.
vessels and decreased in cerebral
tissue perfusion

Weakness, loss of MRI scan,

Cerebral infarction
sensation on the angiograp
opposite side of the hy, CT
body, abnormal pupil scan
dilation,
light reaction and lack
of eye movement on
opposite side, speech
will be slurred,

Cerebrovascular accident
Neurological impairement
Death