Neurocysticercosis is a disease associated with the most dangerous parasites, often mistaken for neurological disorders, leading to late diagnosis when the larvae of the pork tapeworm have already caused brain damage.
Causes of Neurocysticercosis
The disease is caused through consumption of contaminated food, particularly due to habits such as eating raw blood pudding, raw fish, undercooked meat, or unwashed raw vegetables. The larvae in contaminated food enter the digestive tract, penetrate the intestinal mucosa, and travel through the bloodstream to various organs, usually settling in the skin, muscles, brain, or eyes.
It is also possible for the larvae to move via the bloodstream to the brain, lungs, liver, etc., and cause disease. If the larvae settle in the brain, they will cause illness. The disease is commonly found in areas with low living standards and poor hygiene, especially in regions with a tradition of free-range pig farming.
Preventing neurocysticercosis by eating cooked food and boiling water, avoiding raw blood pudding…
Symptoms of Neurocysticercosis
The clinical symptoms of neurocysticercosis usually do not present any specific signs if the cysts are only located in the skin or muscles. Sometimes, they are discovered incidentally through calcified nodules seen on chest X-rays or in limbs.
The severity of damage depends on the number of cysts present in the brain. Common symptoms include: persistent headaches, nausea or vomiting, seizures (epilepsy), hemiplegia or sensory disturbances, insomnia or sleep disturbances, blurred vision, increased intracranial pressure, nervous exhaustion, psychiatric disorders, and potential sudden death.
Most patients with neurocysticercosis experience prolonged headaches or seizures, undergoing treatment at primary healthcare facilities for months or even years without relief, often misdiagnosed as headaches or epilepsy. When undergoing a CT scan, images of brain cysts can be easily detected, typically presenting as large cysts measuring 0.5 to 1 cm.
Stages of Neurocysticercosis
Stage 1 – Non-cystic: In this stage, the embryos of the parasite are not visible on CT or MRI scans. However, mild edema can be observed. Within a few months, these will progress to lesions as the embryos develop into characteristic cysts.
Stage 2 – Fluid-filled cysts: The cysts have translucent walls, containing clear fluid and the parasite inside. If these cysts remain intact, the patient will not exhibit any symptoms.
Stage 3 – Cysticercus: The walls of the cysts thicken, and the fluid inside becomes more turbid, leading to severe inflammatory reactions in the patient. This indicates a worsening condition. In this stage, images of edema can be seen on X-rays, and patients often experience seizures.
Stage 4 – Granulomatous cysts: In this stage, the edema decreases, but seizures and epilepsy may still occur. Epileptic episodes are common during the cysticercus and granulomatous stages due to inflammatory regions surrounding the inactive parasites.
Stage 5 – Calcification: This occurs after the parasites are no longer active. Seizures may still occur due to inflammation caused by the immune system’s response to the remnants of the parasites.
Treatment for Neurocysticercosis
For treatment, patients with neurocysticercosis are prescribed specific medications that are effective only against active forms of the parasite and should be administered in specialized medical facilities. In practice, treatment for larval infection depends on the progression stage of the larvae and its associated complications.
If the parasite is no longer alive, the approach is as follows:
- The primary treatment is symptomatic relief.
- Anticonvulsant medications are used to treat seizures.
- The duration of treatment remains uncertain.
If the parasite is alive or active, other treatments include:
- For patients with vasculitis, arachnoiditis, or encephalitis: a course of steroids or immunosuppressants is recommended before using the specific antiparasitic medications.
- Treatment with albendazole is also beneficial in cases of multiple cysticercus infections (e.g., multiple cysts in the brain resembling a bunch of grapes – “racemose” form).
- Patients with lesions in the parenchyma, under the arachnoid membrane, or spinal cysts without complications (e.g., chronic epilepsy, headaches, neurological signs related to stroke, hydrocephalus): can be treated specifically for the pork tapeworm, with simultaneous use of steroids.
Multiple trials for specific treatment of pork tapeworm may be required for giant subarachnoid cysts. - Patients with epilepsy caused by living cysts in the brain parenchyma: antiparasitic treatment.
For cases with complications, if epilepsy is present, treatment should be as for ordinary epilepsy. If the tapeworm causes damage to the eyes, treatment should focus on reducing edema and pressure, sometimes requiring surgical intervention.
Neurocysticercosis can lead to severe complications such as stroke and can even be life-threatening if not detected and treated in a timely manner.
Medical Recommendations
- Practice eating cooked food and boiling water, avoid raw blood pudding, offal, raw salads, and undercooked pork… Do not eat raw or undercooked water plants like water spinach, water celery, etc., and ensure they are thoroughly cooked before consumption;
- Wash hands before eating and after using the restroom;
- Maintain a clean environment;
- Construct sanitary latrines, and avoid open defecation;
- Avoid free-range pig farming;
- Use antiparasitic medications if infected with tapeworms;
- Seek medical attention promptly if experiencing frequent headaches, dizziness, or other concerning symptoms.
Patient with 50 cysts in the brain
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