CEREBROVASCULAR COMPLICATIONS OF NEUROCYSTICERCOSIS - CLINICAL AND NEUROIMAGING SPECTRUM

Objective: To describe the clinical and neuroimaging spectrum of cereb ral Cysticercus arteritis to clarify the mechanisms of a stroke that i s associated with neurocysticercosis. Design: Case series. Setting: Te rtiary care center. Patients: Sixty-five patients with strokes that we re associated with neurocysticercosis. Based on the extension of cysti cercosis, the study group was divided into patients with focal or diff use cysticercal disease. Patients with focal affection were subdivided into those with small- and large-vessel angiitis. Measures: For each group, stroke syndromes, mode of onset, associated neurologic syndrome s, neuroimaging features of cysticercosis and cerebral infarcts, angio graphic and cerebrospinal fluid findings, and outcome were analyzed. R esults: Thirty-five patients had focal cysticercosis (13 with small- a nd 22 with large-vessel angiitis), and 30 had diffuse disease with eit her small- or large-vessel involvement. A high frequency of subarachno idal cysts was found, neighboring the ischemic area. Patients with foc al cysticercosis had a vascular onset in 80% compared with 20% in thos e with diffuse cysticercosis (P<.001). Distinctive findings in diffuse cysticercosis were hydrocephalus (80%), multiple cerebral infarcts (6 4%), and mental disorders (43%) (P<.001). There was a close parallelis m between the type of cysticercosis and the degree of cerebrospinal fl uid inflammatory changes, reflecting in the outcome. Death or incapaci tating sequelae were associated with diffuse cysticercosis, and total recovery was common in patients with focal disease and small-vessel an giitis, whereas intermediate morbimortality occurred with focal cystic ercosis and large-vessel vasculitis. Conclusion:: Based on the distrib ution of cysticercal disease and the severity of concomitant chronic a rachnoiditis, it is possible to identify a wide spectrum of cerebrovas cular involvement caused by neurocysticercosis.