Natural Progression of Neurocysticercosis Without Treatment

FLAIR MRI: Small lesion (hypointense dot in centre) with minimal perilesional edema (hyperintensity surrounding it)
T1W Post Contrast MRI: Small ring-enhancing lesion
FLAIR MRI Six months later: Increase in the size of edema
T1W Post contrast MRI six months later shows mild increase in size of lesion

Single lesion of neurocysticercosis (tape worm infection of brain) is a common cause of seizures. In most of these cases, only anti-epileptic drugs (AEDs) are advised. Anti-helminthic treatment with albendazole is usually not recommended, as most of these lesions spontaneously resolve over time. This is in contrast to patients with multiple brain lesions in NCC, who are routinely advised to take albendazole along with AEDs.

Here, I have uploaded the MRI scans of a patient with solitary cysticercus granuloma (SCG) done six months apart, who was not treated with albendazole. She has had left-sided headache on and off as the only symptom, she never had seizures.

After seeing an increase in the size of lesion as well as increase in the severity of perilesional edema, I started the patient on albendazole and steroids. I would repeat the MRI after 2-3 months.

Published by Dr Sudhir Kumar MD (Medicine) DM (Neurology)

I am a doctor with 25 years experience. I have worked as a neurologist for about 20 years. Educating public and healthcare professionals is very dear to me. This is possible due to my interactions with thousands of patients and their caregivers. I salute the patients who suffer and it is our duty to minimise suffering by preventing diseases and ensuring prompt diagnosis and treatment of those already affected.

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