Neuro ocular cysticercosis

taenia solium in brain & eye.. diagnosis is clinico- radiological

1. Neuro-ocular cysticercosis By: Dr Rekha Khare MD.Radiology

2. Cysticercosis It is an infection by a parasite Taenia solium , a pork tapeworm forms cysts in different parts of body

3. Neurocysticercosis It is parasitic infestation affecting CNS in about 90% patients with cysticercosis a common neurological disease in developing countries

4. Taenia solium Two host zoonotic cestode Adult stage lies in small intestine of human Gravid proglottid at terminal end of worm full of eggs that are source of infection with larval stage/ cysticercosis

5. Taenia solium contd ….. Intermediate host is pig harvouring larval cyst anywhere in it’s body Human gets infected with cyst by accidental ingestion of T. solium eggs by fecal- oral contamination

6. Clinical presentation Depends on: site of lesion number of lesion host immune response

7. Sites for Neurocysticercosis Meningeal_ basal meninges Parenchymal cerebral cortex rarely white matter Ventricular_ 50%cases in 4 th Spinal cord rare_ blood or ventriculo -ependymal spread

8. Neuro -symptoms/signs Fits/ seizures/ epilepsy-70% Stroke/ TODD paralysis Headache/ Hydrocephalus Neuropsychiatric dysfunction

9. Ocular cysticercosis In 5% cases of cysticercosis Cyst may float freely in anterior/ vitreous chamber Cyst may adhere to retinal & sub retinal tissue Rarely in eyelid & lacrimal gland

10. Ocular- symptoms/signs Chorioretinitis Vitreous detachment Diminution/ loss of vision patient complaints of painful, swollen eye with gradual loss of vision

11. CT findings….. Depends on stage of evolution of infestation 1.Vesicular stage -viable Hypo dense nonenhancing lesion 2. Colloid stage- degeneration Hypo/ isodense lesion with peri . lesional enhancement/ oedma

12. CT finding contd ….. 3.Nodular Granular stage nodular enhancing lesion 4.Active parenchymal stage scolex within a cyst may appear as a hyper dense dot

13. CT finding contd ….. 5 .Calcified stage- parasite dies nodular parenchymal calcification 6. Cysticercotic encephalitis diffuse oedma , collapsed ventricle multiple enhancing parenchymal lesio n

14. Case no. 1 A lady 30yr was sent in the department of Radiology for CT scan of head

15. Case 1 contd. History Severe headache for months Often Fits Patient was treated in village by some quacks. NO RESPONSE

16. Case 1……CECT Head

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22. CT scan finding Most of the brain parenchyma is riddled with numerous cysts of varying size(1-10mm), with dot calcificaion, few nodular calcification & tiny hypodense nonenhancing lesion

23. Diagnosis case no.1 NEURO-CYSTICERCOSIS brain parenchyma is riddled with cysts….. characteristic images with all stages of evolution of parasite

24. Case no.2 A lady aged 40yr came in the department of Radiology for CT scan head

25. Case no.2 contd.History Patient complained of- P ainful swollen eye Headache G radual loss of vision

26. Clinical examination On slit lamp exam two VIABLE MOBILE larva are visualized in anterior chamber of left eye

27. Plain CT scan brain……

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31. Ocular region…..

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33. CT scan finding Few calcifications in posterior ocular wall close to optic nerve head both eye Few dot calcification with minimal perilesional oedma

34. Diagnosis case no. 2 NEURO-OCULAR CYSTICERCOSIS In correlation with slit lamp exam. anterior chamber VIABLE PARASITE SEEN

35. Diagnosis depends on… Clinical history Lab test (enzyme linked immunotransfer blotting) Imaging finding No diagnostic tests identify all cases of cysticercosis

36. Neuroimaging Since the introduction of CT & later MRI, vast majority of single enhancing lesion until then attributed to Tuberculosis were in fact degenerating CYSTICERCI