Neurocysticercosis-New Aspects of Diagnosis and Management after the Introduction of ELISA and Praziquantel

Wang, Kyu Chang; Chung, Chun Kee; Jung, Hee Won; Kim, Dong Gyu; Cho, Byung Kyu; Han, Dae Hee; Choi, Kil Soo; Sim, Bo Sung

Abstract

The diagnosis and management of neurocysticercosis have changed after the recent introduction of Enzyme Linked Immuno-sorbent Assay(ELISA) and praziquantel. Authors reviewed 11 cases of surgically proved neurocysticercosis in which these new diagnostic and therapeutic methods were applied. Age was widely distributed(range 16-59, mean 40 yeats old). Male preponderance was noted as in other reports. ELISA was tested in all cases and 10 out of 11 cases were strongly positive, while 1 case of degenerated cysticercosis was negative. Praziquantel was tried but failed in 5 cases before surgical intervention. Removed cysticerci were located in the fourth ventricle(5 cases), the parenchyme(3 cases), the lateral ventricle(1 case), the cistern-parenchyme(1 case), and the cisterna magna(1 case). Conclusions were as followings : ELISA was reliable in the diagnosis, but was deceitful as a quantitative base during follow-up. If progressive hydrocephalus was detected on the follow-up brain CT(computerized tomography) and no improvement was found clinically after praziquantel therapy in the case of positive ELISA and hydrocephalus, authors recommend ventriculography in the case of suspicious intraventricular lesion, or recommend shunting procedure in simple hydrocephalus. If the apparent mass disappeared after praziquantel or surgical intervention in the case of positive ELISA, but no improvement occurred clinically, then authors recommend considering of mixed type cysticercosis and performing the diagnosis work-up.