Cysticercosis - Revision history

Rossdonaldson1 at 12:08, 14 November 2020

2020-11-14T12:08:57Z

← Older revision		Revision as of 12:08, 14 November 2020
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	==Background==		==Background==
	[[File:Life cycle.gif\|Life cycle of ''Taenia solium''.]]		[[File:Life cycle.gif\|thumb\|Life cycle of ''Taenia solium''.]]
	*[[Parasitic infection]] caused by larval stage of ''Taenia solium'' (pork tapeworm)<ref>CDC Cysticercosis http://www.cdc.gov/parasites/cysticercosis/</ref>		*[[Parasitic infection]] caused by larval stage of ''Taenia solium'' (pork tapeworm)<ref>CDC Cysticercosis http://www.cdc.gov/parasites/cysticercosis/</ref>
	*Occurs when humans (definitive host) ingest poorly cooked pig (intermediate host) that is infected with larvae (cysticerci)		*Occurs when humans (definitive host) ingest poorly cooked pig (intermediate host) that is infected with larvae (cysticerci)

Rossdonaldson1 at 12:08, 14 November 2020

2020-11-14T12:08:40Z

← Older revision		Revision as of 12:08, 14 November 2020
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	==Background==		==Background==
	[[File:~~pic cyst~~.~~png~~\|~~thumbnail~~]]		[[File:Life cycle.gif\|Life cycle of ''Taenia solium''.]]
	*[[Parasitic infection]] caused by larval stage of ''Taenia solium'' (pork tapeworm)<ref>CDC Cysticercosis http://www.cdc.gov/parasites/cysticercosis/</ref>		*[[Parasitic infection]] caused by larval stage of ''Taenia solium'' (pork tapeworm)<ref>CDC Cysticercosis http://www.cdc.gov/parasites/cysticercosis/</ref>
	*Occurs when humans (definitive host) ingest poorly cooked pig (intermediate host) that is infected with larvae (cysticerci)		*Occurs when humans (definitive host) ingest poorly cooked pig (intermediate host) that is infected with larvae (cysticerci)
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	{{Seizure DDX}}		{{Seizure DDX}}
	==Evaluation==		==Evaluation==
			[[File:pic cyst.png\|thumb\|Cysticercosis on brain CT.]]
	===Workup===		===Workup===
	*Imaging is usually best		*Imaging is usually best

Rossdonaldson1: /* Background */

2020-11-14T12:07:36Z

Background

← Older revision		Revision as of 12:07, 14 November 2020
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	==Background==		==Background==
	[[File:pic cyst.png\|thumbnail]]		[[File:pic cyst.png\|thumbnail]]
	*[[Parasitic infection]] caused by larval stage of ''Taenia solium'' (pork tapeworm)<ref>CDC Cysticercosis http://www.cdc.gov/parasites/cysticercosis/</ref>		*[[Parasitic infection]] caused by larval stage of ''Taenia solium'' (pork tapeworm)<ref>CDC Cysticercosis http://www.cdc.gov/parasites/cysticercosis/</ref>
	*Occurs when humans (definitive host) ingest poorly cooked pig (intermediate host) that is infected with larvae (cysticerci)		*Occurs when humans (definitive host) ingest poorly cooked pig (intermediate host) that is infected with larvae (cysticerci)

ClaireLewis at 00:53, 2 October 2019

2019-10-02T00:53:43Z

← Older revision		Revision as of 00:53, 2 October 2019
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	**Most common presentation of NCC		**Most common presentation of NCC
	**Most cases are asymptomatic and discovered incidentally after resolution of infection (see image below)		**Most cases are asymptomatic and discovered incidentally after resolution of infection (see image below)
	**Those with symptoms usually present with seizures (focal or generalized)		**Those with symptoms usually present with [[seizures]] (focal or generalized)
	**Focal neurologic ~~deficit~~		**[[Focal neurologic deficits]]
	*Extraparenchymal NCC: more often present with headaches, vomiting, hydrocephalus		*Extraparenchymal NCC: more often present with [[headaches]], [[vomiting]], [[hydrocephalus]]
	**Intraventricular cysts: can get lodged in ventricular outflow tracts and cause obstructive hydrocephalus and [[increased ICP]] causing [[nausea]], [[vomiting]], [[altered mental status]], [[papilledema]]		**Intraventricular cysts: can get lodged in ventricular outflow tracts and cause obstructive hydrocephalus and [[increased ICP]] causing [[nausea]], [[vomiting]], [[altered mental status]], [[papilledema]]
	**Subarachnoid cysts: can cause inflammatory response leading to arachnoiditis which may result in hydrocephalus, [[meningitis]], [[stroke]], and vasculitis		**Subarachnoid cysts: can cause inflammatory response leading to arachnoiditis which may result in [[hydrocephalus]], [[meningitis]], [[stroke]], and [[vasculitis]]
	**Ocular (1-3% of cases): [[diplopia]] if EOM involvement, vision loss or pain if intra-ocular		**Ocular (1-3% of cases): [[diplopia]] if EOM involvement, vision loss or pain if intra-ocular
	**Spinal (1% of cases): radicular pain, paresthesias, [[cauda equina]] symptoms		**Spinal (1% of cases): radicular pain, [[paresthesias]], [[cauda equina]] symptoms

	==Differential Diagnosis==		==Differential Diagnosis==
	*Brain abscess		*[[Brain abscess]]
	*Vasculitis		*[[Vasculitis]]
	*Tuberculomas or Mycotic granulomas		*[[TB\|Tuberculomas]] or Mycotic granulomas
	*Primary brain tumors or metastases		*Primary [[brain tumors]] or metastases

	{{Seizure DDX}}		{{Seizure DDX}}
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	===Workup===		===Workup===
	*Imaging is usually best		*Imaging is usually best
	**CT head (calcifications/edema); MRI (cysts +/- scolex, edema)<ref>García HH, Del Brutto OH. Imaging findings in neurocysticercosis. Acta Trop. 2003;87(1):71-8</ref>		**[[CT head]] (calcifications/edema); [[brain MRI\|MRI]] (cysts +/- scolex, edema)<ref>García HH, Del Brutto OH. Imaging findings in neurocysticercosis. Acta Trop. 2003;87(1):71-8</ref>
	**X-rays or CT for extraneural cysticercosis		**X-rays or CT for extraneural cysticercosis
	*EITB assay for anticysticercal antibody		*EITB assay for anticysticercal antibody
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	**Usually not helpful		**Usually not helpful
	**[[Eosinophilia]] not seen unless cyst is leaking/ruptured		**[[Eosinophilia]] not seen unless cyst is leaking/ruptured
	*Depending on presentation, involvement of the following services may be needed:
	**Neurology: for seizures refractory to meds
	**Neurosurgery: hydrocephalus, mass effect, herniation
	**Infectious disease: if starting antiparasitic therapy
	**Ophthalmology: if suspect ocular involvement or if starting antibiotics and need to confirm no ocular involvement

	===Evaluation===		===Evaluation===
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	*Typically observation		*Typically observation
	**If just one lesion or cosmetic issue, surgical excision		**If just one lesion or cosmetic issue, surgical excision
	**Otherwise: NSAIDs		**Otherwise: [[NSAIDs]]

	===Symptomatic Neurocysticercosis===		===Symptomatic Neurocysticercosis===
	*[[Anticonvulsants]] ([[keppra]], [[dilantin]], newer agents)		*[[Anticonvulsants]] ([[keppra]], [[dilantin]], newer agents)
	*Antihelminthic therapy and steroids		*[[antiparasitics\|Antihelminthic therapy]] and [[steroids]]
	**Treat if edema, mass effect, or vasculitis		**Treat if edema, mass effect, or vasculitis
	**Don’t treat if old calcifications on CT without edema		**Don’t treat if old calcifications on CT without edema
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	===Ocular===		===Ocular===
	*Intra-ocular: surgery <ref>Sharma T. et al. Intraocular cysticercosis: clinical characteristics and visual outcome after vitreoretinal surgery. Ophthalmology. 2003;110(5):996-1004</ref>		*Intra-ocular: surgery <ref>Sharma T. et al. Intraocular cysticercosis: clinical characteristics and visual outcome after vitreoretinal surgery. Ophthalmology. 2003;110(5):996-1004</ref>
	*Extra-ocular muscle involvement: albendazole and steroids<ref>Sundaram PM, Jayakumar N, Noronha V. Extraocular muscle cysticercosis - a clinical challenge to the ophthalmologists. Orbit. Dec 2004;23(4):255-62</ref>		*Extra-ocular muscle involvement: [[albendazole]] and [[steroids]]<ref>Sundaram PM, Jayakumar N, Noronha V. Extraocular muscle cysticercosis - a clinical challenge to the ophthalmologists. Orbit. Dec 2004;23(4):255-62</ref>
	*Spinal intramedullary: possibly surgery		*Spinal intramedullary: possibly surgery

	===Pregnant===		===Pregnant===
	*Consult OBGYN		*Consult OBGYN
	*Avoid any antiparasitics (associated with early worsening in seizure activity). In most cases, therapy should be deferred until after delivery		*''Avoid'' any antiparasitics (associated with early worsening in seizure activity). In most cases, therapy should be deferred until after delivery

	==[[Antiparasitic]] Treatment==		==[[Antiparasitic]] Treatment==

KOkamoto: /* Management */

2019-04-10T08:57:45Z

Management

← Older revision		Revision as of 08:57, 10 April 2019
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	*Extra-ocular muscle involvement: albendazole and steroids<ref>Sundaram PM, Jayakumar N, Noronha V. Extraocular muscle cysticercosis - a clinical challenge to the ophthalmologists. Orbit. Dec 2004;23(4):255-62</ref>		*Extra-ocular muscle involvement: albendazole and steroids<ref>Sundaram PM, Jayakumar N, Noronha V. Extraocular muscle cysticercosis - a clinical challenge to the ophthalmologists. Orbit. Dec 2004;23(4):255-62</ref>
	*Spinal intramedullary: possibly surgery		*Spinal intramedullary: possibly surgery

			===Pregnant===
			*Consult OBGYN
			*Avoid any antiparasitics (associated with early worsening in seizure activity). In most cases, therapy should be deferred until after delivery

	==[[Antiparasitic]] Treatment==		==[[Antiparasitic]] Treatment==

Ostermayer: /* Antiparasitic Treatment */

2019-01-18T22:54:09Z

Antiparasitic Treatment

← Older revision		Revision as of 22:54, 18 January 2019
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	==[[Antiparasitic]] Treatment==		==[[Antiparasitic]] Treatment==
	''If hydrocephalus is present, CSF diversion with ventriculostomy or VP shunt by Neurosurgery and/or surgical resection of cysts is recommended rather than antiparastic treatment''		''If hydrocephalus is present, CSF diversion with ventriculostomy or VP shunt by Neurosurgery and/or surgical resection of cysts is recommended rather than antiparastic treatment''
	~~===[[Albendazole]]===~~
	*15mg/kg/day divided in 2 doses<ref>Garcia HH, Pretell EJ, Gilman RH, et al. A trial of antiparasitic treatment to reduce the rate of seizures due to cerebral cysticercosis. N Engl J Med. 2004;350(3):249-58.</ref>		{{Neurocysticercosis antibiotics}}
	**First line therapy
	~~===[[Praziquantel]]===~~
	*Second line therapy
	*50-100mg/kg/day divided in 3 doses <ref>Sotelo J. et al. Albendazole vs praziquantel for therapy for neurocysticercosis. A controlled trial. Arch Neurol. May 1988;45(5):532-4</ref>
	===Steroids===		===Steroids===
	*[[Prednisone]] 1mg/kg/day (60mg max) or [[dexamethasone]] 0.1mg/kg/day (10mg max)		*[[Prednisone]] 1mg/kg/day (60mg max) or [[dexamethasone]] 0.1mg/kg/day (10mg max)

ClaireLewis: /* Antiparasitic Treatment */

2017-03-28T17:57:27Z

Antiparasitic Treatment

← Older revision		Revision as of 17:57, 28 March 2017
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	*Spinal intramedullary: possibly surgery		*Spinal intramedullary: possibly surgery

	==Antiparasitic Treatment==		==[[Antiparasitic]] Treatment==
	''If hydrocephalus is present, CSF diversion with ventriculostomy or VP shunt by Neurosurgery and/or surgical resection of cysts is recommended rather than antiparastic treatment''		''If hydrocephalus is present, CSF diversion with ventriculostomy or VP shunt by Neurosurgery and/or surgical resection of cysts is recommended rather than antiparastic treatment''
	===[[Albendazole]]===		===[[Albendazole]]===

Rossdonaldson1: Text replacement - "AMS" to "altered mental status"

2016-07-30T11:39:52Z

Text replacement - "AMS" to "altered mental status"

← Older revision		Revision as of 11:39, 30 July 2016
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	**Focal neurologic deficit		**Focal neurologic deficit
	*Extraparenchymal NCC: more often present with headaches, vomiting, hydrocephalus		*Extraparenchymal NCC: more often present with headaches, vomiting, hydrocephalus
	**Intraventricular cysts: can get lodged in ventricular outflow tracts and cause obstructive hydrocephalus and [[increased ICP]] causing [[nausea]], [[vomiting]], [[~~AMS~~]], [[papilledema]]		**Intraventricular cysts: can get lodged in ventricular outflow tracts and cause obstructive hydrocephalus and [[increased ICP]] causing [[nausea]], [[vomiting]], [[altered mental status]], [[papilledema]]
	**Subarachnoid cysts: can cause inflammatory response leading to arachnoiditis which may result in hydrocephalus, [[meningitis]], [[stroke]], and vasculitis		**Subarachnoid cysts: can cause inflammatory response leading to arachnoiditis which may result in hydrocephalus, [[meningitis]], [[stroke]], and vasculitis
	**Ocular (1-3% of cases): [[diplopia]] if EOM involvement, vision loss or pain if intra-ocular		**Ocular (1-3% of cases): [[diplopia]] if EOM involvement, vision loss or pain if intra-ocular
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	*Home if asymptomatic or no complications with good pain control		*Home if asymptomatic or no complications with good pain control
	*Admit if starting antihelminthic therapy for further testing as listed above and to monitor initial side effects of drug therapy		*Admit if starting antihelminthic therapy for further testing as listed above and to monitor initial side effects of drug therapy
	*ICU for uncontrolled [[seizures]], [[~~AMS~~]], [[increased ICP]]		*ICU for uncontrolled [[seizures]], [[altered mental status]], [[increased ICP]]

	==See Also==		==See Also==

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-22T06:14:25Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 06:14, 22 July 2016
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	{{Seizure DDX}}		{{Seizure DDX}}
	==~~Diagnosis~~==		==Evaluation==
	===Workup===		===Workup===
	*Imaging is usually best		*Imaging is usually best

Neil.m.young: Text replacement - "0 mg" to "0mg"

2016-07-18T20:29:17Z

Text replacement - "0 mg" to "0mg"

← Older revision		Revision as of 20:29, 18 July 2016
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	*50-100mg/kg/day divided in 3 doses <ref>Sotelo J. et al. Albendazole vs praziquantel for therapy for neurocysticercosis. A controlled trial. Arch Neurol. May 1988;45(5):532-4</ref>		*50-100mg/kg/day divided in 3 doses <ref>Sotelo J. et al. Albendazole vs praziquantel for therapy for neurocysticercosis. A controlled trial. Arch Neurol. May 1988;45(5):532-4</ref>
	===Steroids===		===Steroids===
	*[[Prednisone]] 1mg/kg/day (~~60 mg~~ max) or [[dexamethasone]] 0.1mg/kg/day (10mg max)		*[[Prednisone]] 1mg/kg/day (60mg max) or [[dexamethasone]] 0.1mg/kg/day (10mg max)

	==Disposition==		==Disposition==