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neurocysticercosis ( ncc ) is one of the most common helminthic infestations affecting the central nervous system ( cns ) .
the clinical manifestations of the disease may vary with the size and location of cysticerci and the intensity of the host 's immune response .
the other clinical conditions include headache , hydrocephalus , chronic meningitis , focal neurological deficits , and psychological disorders .
altered sensorium and raised intracranial pressure ( icp ) may require ventilatory support in an intensive care unit ( icu ) . here ,
a 41-year - old male , presented with history of fever , headache , and episodic seizures for one month . the neurological examination and routine investigations were normal , except for eosinophilia .
a computed tomographic ( ct ) scan of the head showed numerous tiny hypodense foci scattered throughout the brain parenchyma .
cerebrospinal fluid serology was negative for antigens of herpes simplex , tubercular , and japanese encephalitis .
the patient was managed with broad spectrum antibiotics and supportive treatments , but without any improvement .
one week later magnetic resonance image ( mri ) , revealed numerous tiny lesions scattered throughout the brain parenchyma , with relative predilection for a gray - white junction and basal ganglia .
similar lesions were also noted on the scalp , tongue , extraocular muscles , muscles of the face , neck , trunk , and limbs .
the diagnosis of cysticercosis was confirmed after a skin and muscle biopsy was taken , which showed cysticercus surrounded by an intense inflammatory infiltrate .
the patient was treated with pyrantal pamoate , mannitol , steroids , and sodium valproate . however , the sensorium deteriorated with a glasgow coma score ( gcs ) of e2v1m4 .
repeat mri of the brain done two weeks later showed similar findings without any parenchymal edema . in view of the prolonged mechanical ventilation
oral albendazole was added to the treatment regimen . at present , after two months of treatment , the patient is on room air with a gcs of e4vttm2 .
magnetic resonance image ( t2 weighted ) of the brain shows numerous tiny lesions ( neurocysticercosis ) scattered throughout brain parenchyma with relative predilection for a gray - white junction and basal ganglia a 35-year - old male , non - vegetarian by diet , was diagnosed as having neurocysticercosis six months back , for which he received oral phenytoin 300 mg , daily . however , non - compliance with the treatment led to three episodes of generalized seizures and altered sensorium . in view of further neurological deterioration ,
a contrast - enhanced ct scan of the brain showed multiple ring enhancing lesions of ncc in the bilateral hemispheres , with left ventricular hydrocephalus [ figure 2 ] .
external ventricular drainage ( evd ) was done , but without much improvement in the sesorium .
the patient underwent surgery the next day after admission , for endoscopic removal of the ventricular neurocysticerci followed by insertion of a ventriculoperitoneal shunt .
the lungs were ventilated till the gcs improved to full score , following which the trachea was extubated .
postoperatively , the medical management included administration of phenytoin and steroids ; cysticidal therapy was not given considering the presence of an intraventricular cyst .
he was discharged after three weeks of hospital stay with advice for follow - up .
contrast - enhanced computed tomographic scan of the brain shows multiple ring enhancing lesions in the bilateral hemispheres , with the ventricular end of the shunt - catheter in situ
a 41-year - old male , presented with history of fever , headache , and episodic seizures for one month . the neurological examination and routine investigations were normal , except for eosinophilia .
a computed tomographic ( ct ) scan of the head showed numerous tiny hypodense foci scattered throughout the brain parenchyma .
cerebrospinal fluid serology was negative for antigens of herpes simplex , tubercular , and japanese encephalitis .
the patient was managed with broad spectrum antibiotics and supportive treatments , but without any improvement .
one week later magnetic resonance image ( mri ) , revealed numerous tiny lesions scattered throughout the brain parenchyma , with relative predilection for a gray - white junction and basal ganglia .
similar lesions were also noted on the scalp , tongue , extraocular muscles , muscles of the face , neck , trunk , and limbs .
the diagnosis of cysticercosis was confirmed after a skin and muscle biopsy was taken , which showed cysticercus surrounded by an intense inflammatory infiltrate .
the patient was treated with pyrantal pamoate , mannitol , steroids , and sodium valproate . however , the sensorium deteriorated with a glasgow coma score ( gcs ) of e2v1m4 .
repeat mri of the brain done two weeks later showed similar findings without any parenchymal edema . in view of the prolonged mechanical ventilation
oral albendazole was added to the treatment regimen . at present , after two months of treatment , the patient is on room air with a gcs of e4vttm2 .
magnetic resonance image ( t2 weighted ) of the brain shows numerous tiny lesions ( neurocysticercosis ) scattered throughout brain parenchyma with relative predilection for a gray - white junction and basal ganglia a 35-year - old male , non - vegetarian by diet , was diagnosed as having neurocysticercosis six months back , for which he received oral phenytoin 300 mg , daily . however , non - compliance with the treatment led to three episodes of generalized seizures and altered sensorium . in view of further neurological deterioration ,
a contrast - enhanced ct scan of the brain showed multiple ring enhancing lesions of ncc in the bilateral hemispheres , with left ventricular hydrocephalus [ figure 2 ] .
external ventricular drainage ( evd ) was done , but without much improvement in the sesorium .
the patient underwent surgery the next day after admission , for endoscopic removal of the ventricular neurocysticerci followed by insertion of a ventriculoperitoneal shunt .
the lungs were ventilated till the gcs improved to full score , following which the trachea was extubated .
postoperatively , the medical management included administration of phenytoin and steroids ; cysticidal therapy was not given considering the presence of an intraventricular cyst .
he was discharged after three weeks of hospital stay with advice for follow - up .
contrast - enhanced computed tomographic scan of the brain shows multiple ring enhancing lesions in the bilateral hemispheres , with the ventricular end of the shunt - catheter in situ
a 41-year - old male , presented with history of fever , headache , and episodic seizures for one month . the neurological examination and routine investigations were normal , except for eosinophilia .
a computed tomographic ( ct ) scan of the head showed numerous tiny hypodense foci scattered throughout the brain parenchyma .
cerebrospinal fluid serology was negative for antigens of herpes simplex , tubercular , and japanese encephalitis .
the patient was managed with broad spectrum antibiotics and supportive treatments , but without any improvement .
one week later magnetic resonance image ( mri ) , revealed numerous tiny lesions scattered throughout the brain parenchyma , with relative predilection for a gray - white junction and basal ganglia .
similar lesions were also noted on the scalp , tongue , extraocular muscles , muscles of the face , neck , trunk , and limbs .
the diagnosis of cysticercosis was confirmed after a skin and muscle biopsy was taken , which showed cysticercus surrounded by an intense inflammatory infiltrate .
the patient was treated with pyrantal pamoate , mannitol , steroids , and sodium valproate . however , the sensorium deteriorated with a glasgow coma score ( gcs ) of e2v1m4 .
repeat mri of the brain done two weeks later showed similar findings without any parenchymal edema . in view of the prolonged mechanical ventilation
oral albendazole was added to the treatment regimen . at present , after two months of treatment , the patient is on room air with a gcs of e4vttm2 .
magnetic resonance image ( t2 weighted ) of the brain shows numerous tiny lesions ( neurocysticercosis ) scattered throughout brain parenchyma with relative predilection for a gray - white junction and basal ganglia
a 35-year - old male , non - vegetarian by diet , was diagnosed as having neurocysticercosis six months back , for which he received oral phenytoin 300 mg , daily . however , non - compliance with the treatment led to three episodes of generalized seizures and altered sensorium . in view of further neurological deterioration ,
a contrast - enhanced ct scan of the brain showed multiple ring enhancing lesions of ncc in the bilateral hemispheres , with left ventricular hydrocephalus [ figure 2 ] .
external ventricular drainage ( evd ) was done , but without much improvement in the sesorium .
the patient underwent surgery the next day after admission , for endoscopic removal of the ventricular neurocysticerci followed by insertion of a ventriculoperitoneal shunt .
the lungs were ventilated till the gcs improved to full score , following which the trachea was extubated .
postoperatively , the medical management included administration of phenytoin and steroids ; cysticidal therapy was not given considering the presence of an intraventricular cyst .
he was discharged after three weeks of hospital stay with advice for follow - up .
contrast - enhanced computed tomographic scan of the brain shows multiple ring enhancing lesions in the bilateral hemispheres , with the ventricular end of the shunt - catheter in situ
neurocysticercosis ( cyst lodged in the cns ) is the most common form of human cysticercosis , with the brain parenchyma being the most common site .
it is the main cause of acquired epilepsy and neurological morbidity in many of the developing countries . as per the estimation by the world health organization ( who ) , over 50 000 deaths occur due to ncc each year , and many times an equal number of people have active epilepsy , with all the social and economic consequences that this implies .
mri is considered the best neuroimaging tool for the detection of degenerating and innocuous ( viable ) cysticerci , while ct is better for calcified lesions .
the added advantage of mri is that it can differentiate the stages of the parasite , which ct fails to do .
enzyme - linked immunoelctrotransfer blot ( eitb ) with 100% sensitivity and an overall 98% specificity is used , currently , in most of the centers .
cases of human cysticercosis with such extensive dissemination , involving all possible sites , namely , the brain , spinal cord , eyes , muscles , and subcutaneous tissues simultaneously , are indeed very rare . we report case with extensive involvement of brain parenchyma , muscles of thorax , abdomen , and thigh ( case 1 ) . in this case , sudden neurological deterioration required tracheal intubation and mechanical ventilation . although the patient received antihelminthic , antiepileptic , and steroid medications , there was no significant neurological improvement . after tracheostomy the patient was gradually weaned off the ventilator and was able to maintain a normal saturation of arterial oxygenation , on room air .
llompart pou et al . reported a case , who came to the emergency department with complaints of severe headache for six hours .
the cyst possibly caused obstruction to the flow of csf by migration through the aqueduct of sylvius .
during a two - to - five day antiparasitic therapy , exacerbation of neurological symptoms occurred , which was attributable to local inflammation , following the death of the larvae . for this reason ,
both albendazole and praziquantel were generally given along with steroids for the control of cerebral edema that may occur after antiparasitic therapy .
seizure is the most common symptom occurring in 70  90% of the patients with ncc .
however , non - compliance to treatment in our patient led to repeated episodes of seizures , with altered sensorium . in patients with intracranial hypertension secondary to ncc
antiparasitic drug treatment is never the primary treatment modality , especially in the setting of elevated icp . for intraventricular cysts ,
hydrocephalus is managed with a ventriculoperitoneal shunt , but these shunts suffer frequent blockade by small cysts or inflammatory exudates , and require multiple revisions .
ncc is a preventable disease ; however , control of intracranial hypertension or epileptic syndromes are the mainstay of management during acute presentations .
neurocysticercosis ( ncc ) , a common helminthic infestation in developing countries , may cause acquired epilepsy and neurological morbidities . 
 acute symptomatic seizure is the most common manifestation . 
 the other clinical conditions include headache , hydrocephalus , chronic meningitis , focal neurological deficits , and psychological disorders . 
 altered sensorium and raised intracranial pressure ( icp ) may require ventilatory support in an intensive care unit ( icu ) . 
 definitive diagnosis is made by identification of parasites in tissues or by a radiological demonstration of the scolex in cystic lesions . 
 antiepileptic drugs are used to control seizures after ncc . 
 steroids are generally administered along with antihelminthics , in order to control the edema and intracranial hypertension that may occur as a result of antiparasitic medications . in patients with intracranial hypertension , 
 the priority is to manage the icp before considering other treatment options . 
 antiparasitic drug treatment is never the mainstay of treatment , especially in the setting of elevated icp . here , 
 we present the icu management of two such cases .