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Autochthonous neurocysticercosis is exceptionally rare in Western Europe. We describe multiple brain lesions, initially mimicking metastases, in a 60-year-old man in Spain without travel history. We confirmed diagnosis by neuroimaging and positive serology. Our study highlights cryptic local Taenia solium nematode transmission risks and diagnostic challenges in nonendemic regions.

Neurocysticercosis is the most common helminthic parasitic disease affecting the human central nervous system and is pleomorphic in its presentation. It is frequently encountered in daily practice in most parts of the world, and also commonly seen in industrialized countries in immigrant populations. In the past decade, new treatment (combined anti-parasitic drugs, increased attention to reducing treatment-associated inflammation and damage, new surgical strategies), and diagnostic (more specific antigen and antibody detection concepts and tools, more sensitive magnetic resonance imaging sequences) approaches, new animal models, and data on control of transmission have emerged. Still, diagnostic challenges persist and treatment approaches for some types of disease may differ, affecting clinical practice. This review provides clinicians in endemic and non-endemic countries with a comprehensive and practical reference to understand the variabilities in clinical expression of the disease and the optimal diagnostic and treatment approaches.

We present a case of subarachnoid neurocysticercosis caused by Taenia crassiceps in an elderly woman in Slovenia with no underlying disease or immunosuppressive treatment. The parasite was identified by 12S rDNA PCR and sequencing. Despite prolonged therapy with albendazole and praziquantel, the disease recurred after treatment was discontinued.

BackgroundThere is a paucity of literature to support 14-days albendazole therapy for neurocysticercosis (NCC).ObjectiveTo compare the efficacy of 14-day and 28-day albendazole therapy in the management of children with newly diagnosed active NCC.Study designOpen-labelled randomized controlled trialParticipantsChildren aged 1–14 years with newly diagnosed active neurocysticercosis.InterventionAlbendazole (15 mg/kg/day) for either 14 days or 28 days.OutcomeThe primary outcome measure was proportion of children with radiological resolution of active lesion at 6-month follow up. Secondary outcome measures were proportion of children with seizure recurrence, duration to seizure recurrence and calcification on follow up imaging.Results65 children with newly diagnosed NCC were randomized to receive albendazole therapy for 14 days (n=32) or 28 days (n=33). The proportion of children with complete resolution was comparable between the two groups [6 (18.8%) vs. 9 (27.3%); OR (95%CI):0.61 (0.19 to 1.98); P=0.56]. Similarly, proportion of children with seizure recurrence [5(15.6%) vs 2(6.1%); OR (95%CI): 2.87(0.51–16.0); P=0.26] and proportion of children with calcification on follow-up imaging [26(81.2%) vs 23(69.7%); OR (95%CI): 1.88 (0.59–5.99); P=0.39] were also comparable. There were no major side-effects noted during the study.Conclusion14-day treatment with albendazole therapy is as effective as 28-day treatment in achieving radiological resolution at six-month follow up. However, high rate of calcification in both the groups indicates need for further evaluation with an adequately powered study and longer follow up

Neurocysticercosis (NCC) is a central nervous system infection caused by the larval form of the tapeworm Taenia solium, endemic in Latin America and Asia. It can present as intraparenchymal or racemose (rNCC) forms, with symptoms including epilepsy, headaches, and intracranial hypertension. We present two cases of rNC from Chile with significant cognitive symptoms. First case is a 79-year-old male farmer with suspected normal pressure hydrocephalus (NPH). Symptoms included progressive forgetfulness, disorientation, gait disorder, and headache over four years. Investigations included a magnetic resonance of the brain (MRI) that revealed multiple subarachnoid cysts and hydrocephalus compatible with rNCC. Cerebrospinal fluid (CSF) analysis showed pleocytosis, hyperproteinorrhacia, and hypoglycorrhachia. Blood Enzyme-Linked ImmunoSorbent Assay (ELISA) and CSF Western blot (WB) confirmed cysticercosis. He was treated with corticosteroids, albendazole, and praziquantel over a month. Follow-up neuroimaging showed decreased ventricular widening and cysts volume. Second case is a 58-year-old male from Santiago who presented with confusion, agitation, disconnection episodes, and headache over two months. An MRI revealed signs of basal meningitis and interhemispheric and anterior cistern cysts with leptomeningeal enhancement. CSF had pleocytosis, hyperproteinorrhacia, and hypoglycorrhachia. ELISA and WB confirmed cysticercosis. He began treatment with albendazole and corticosteroids, completing 30 days. Follow-up MRI confirmed almost complete resolution of the lesions. Both cases presented with prominent cognitive features, with the first case resembling NPH and the second case presenting as a subacute confusional state/rapidly progressive dementia. Corticosteroids plus antiparasitic drugs led to significant improvements in MRI abnormalities, with no major complications. Although the cognitive symptoms showed considerable improvement, they did not completely resolve. Although rare, rNCC should be considered as a differential diagnosis for a wide range of neurological conditions in regions where NCC is common. Atypical clinical findings and headache should be regarded as warning signs. T2 and T1 gadolinium-enhanced MRI sequences were essential in assessing these cases. CSF showed a characteristic profile, and blood ELISA and CSF WB were able to confirm the diagnosis. Treatment with antiparasitic drugs combined with corticosteroids appears to be effective and well tolerated. Further research is necessary to improve the diagnosis and treatment of rNCC.

Neurocysticercosis (NCC) is a neglected parasitic disease that causes neurological symptoms. However, little is known about the long-term impact of this infection on health. We contacted participants from a randomized controlled trial on albendazole treatment for NCC in Ecuador 12 years after trial completion (14–16 years after NCC diagnosis) about their long-term health. We described the symptoms experienced post-trial and investigated if albendazole treatment, the presence of calcified NC cysts, and cysts in extraparenchymal locations at last imaging predicted symptoms. All analyses were standardized by adjusting for participant age and sex. In the 12 years post-trial, 52.1% reported some health problem, with 48.9% reporting neurological symptoms such as seizures (16.6% of participants) and headaches (26.6% of participants). At the end of the trial, 11 participants had complete NCC cyst resolution, of whom 3 (27.3%) reported seizures and 1 (9.1%) reported headaches post-trial. Twenty-four participants had only calcified cysts (residual calcification sometimes left after the parasite dies) by trial end, of whom 8 (33.3%) reported seizures and 9 (37.5%) headaches post-trial. None of the predictors examined were significantly associated with long-term symptoms. A high proportion of people diagnosed with NCC continue experiencing symptoms years after treatment, and while slightly fewer people experienced continued symptoms in the albendazole group, the difference was not statistically significant. Eleven participants with no live parasites at last imaging (8 with residual calcifications) had seizures post-trial, which may be unprovoked and an indication of epilepsy risk. Research is urgently needed to improve NCC treatment to mitigate long-term outcomes.

Background Neurocysticercosis (NCC) is a leading cause of epilepsy and neurological morbidity in endemic regions. This study compares clinical characteristics, treatment, and outcomes between parenchymal and extraparenchymal NCC in northern Thailand. Methods A retrospective cohort of 106 adult NCC patients (2015–2024) was reviewed at Chiang Mai University. Patients were categorized based on neuroimaging. Clinical data, treatment regimens, and functional outcomes (using modified Rankin Scale) were assessed at baseline, discharge, and 3, 6, and 12 months. Results Of 106 patients, 84 (79.2%) had parenchymal and 22 (20.8%) had extraparenchymal NCC. Seizures were more common in parenchymal cases, while sensory deficits and hydrocephalus predominated in extraparenchymal cases. Surgical intervention was significantly more frequent in extraparenchymal NCC (86.4% vs. 4.8%, P  < 0.001). Despite overall improvement, extraparenchymal cases had worse outcomes at all time points. Corticosteroids did not improve long-term function and were linked to more adverse events. Conclusions Parenchymal and extraparenchymal NCC have distinct clinical patterns and outcomes. Extraparenchymal NCC is more severe, frequently requiring surgery and resulting in greater disability. Corticosteroid use showed no association with long-term outcomes, highlighting the need for early diagnosis and tailored treatment strategies. Highlights Parenchymal and extraparenchymal NCC differ in presentation and outcomes. Extraparenchymal NCC shows more severity and often requires surgery. Corticosteroids showed no clear long-term benefit in this cohort. Early diagnosis and tailored care are key in endemic, limited-resource areas.

Aim: The aim of this trial was to evaluate the effects of albendazole (ALB) on cyst disappearance, reduction of the number of cysts and seizure recurrence. Methods: 178 patients with new onset symptoms due to active or transitional neurocysticercosis were randomly assigned to receive either 800 mg of ALB daily or placebo for 8 days. All patients also received prednisone. Imaging studies were done at baseline and at months 1, 6 and 12 of follow-up. Results: Active cysts were identified in 59 of 88 people randomised to ALB and 57 of the 90 in the placebo arm. By 1 month, 31% were free of active cysts in the treatment group compared with 7% in the placebo group (p = 0.001). In addition, the ALB group had a greater reduction in the number of active cysts compared with the placebo group (p = 0.001). After 1 month following treatment there was no additional gain by treatment group in the disappearance or reduction in the number of active cysts. ALB treatment had little effect on cysts in the transitional or calcification stage. We found no difference between the ALB and placebo groups in symptoms during treatment or in seizure recurrence during the 12 months after treatment. Conclusion: Albendazole plus symptomatic treatment leads to the disappearance of active cysts in 31% of patients compared with 7% of those with symptomatic treatment alone. This treatment effect occurs within the first 30 days after treatment. Trial registration number: NCT00283699.

The infection of the nervous system by the cystic larvae of Taenia solium (neurocysticercosis) is a frequent cause of seizure disorders. Neurocysticercosis is endemic or presumed to be endemic in many low-income countries. The lifecycle of the worm and the clinical manifestations of neurocysticercosis are well established, and CT and MRI have substantially improved knowledge of the disease course. Improvements in immunodiagnosis have further advanced comprehension of the pathophysiology of this disease. This knowledge has led to individualised treatment approaches that account for the involvement of parenchymal or extraparenchymal spaces, the number and form of parasites, and the extent of degeneration and associated inflammation. Clinical investigations are focused on development of effective treatments and reduction of side-effects induced by treatment, such as seizures, hydrocephalus, infarcts, and neuroinjury.

Neurocysticercosis (NCC) is the most common helminthic infection of the central nervous system (CNS). When NCC calcifies, it causes symptoms including memory impairment. Here we will assess the frequency and characteristics of cognitive impairment using screening tools in patients with calcified NCC. We performed a cross-sectional study in participants of an ongoing cohort of patients with calcified NCC, who were administered the Mini-Mental State Examination (MMSE) and Memory Alteration Test (MAT) simultaneously. We analyzed these test scores in relation to sociodemographic, clinical, and neuroimaging characteristics. We included 336 individuals, with an average age of 43.6 ± 14.8 years, 56 % of whom were female. The median scores for MMSE and MAT were 27 (IQR 25–28) and 41 (IQR 36–45), respectively. We observed cognitive impairment in 43 (12.8 %) participants with MMSE and 90 (26.8 %) with MAT. Among the 57 participants aged 60 years and older, 17 (29.8 %) had cognitive impairment on MMSE and 29 (50.9 %) on MAT. Lower scores were associated with older age (p < 0.001 for both tests), and the presence of left temporal lobe calcifications (p < 0.001 for both), associations that persisted after multivariate adjustment (p = 0.017 for MMSE and p = 0.043 for MAT). In this cohort, we found that low cognitive scores are frequently observed in patients with calcified NCC (12.8 % by MMSE, 26.8 % by MAT) and are associated with older age and calcifications in the left temporal lobe. Further studies with appropriate control groups are needed to assess these associations beyond screening tools and examine other contributing factors. •Memory-related issues are a common, understudied complaint in neurocysticercosis.•Cognitive impairment was more prevalent in calcified neurocysticercosis.•Calcifications in the left temporal lobe are associated with lower cognitive scores.