MRI AND TREATMENT OF PARENCHYMAL CEREBRAL CYSTICERCOSIS

In the early 1980s, the introduction of praziquantel and of CT and MRI for monitoring cerebral lesions had a revolutionary impact on the man agement of neurocysticercosis. However, MRI findings after treatment h ave raised new problems, in particular regarding the persistence of ac tive disease in some asymptomatic patients and the place of antiparasi tic therapy. Two illustrative cases presented herein suggest a need fo r pondering the efficacy of praziquantel, the apparently paradoxical e ffects of this agent, and the value of pathophysiologic interpretation of cerebral imaging findings. A strategy for treating and monitoring parenchymal cerebral cysticercosis, in which clinical findings are giv en greater weight than changes in reasonably-spaced imaging studies, i s outlined. A prospective evaluation of the validity of this strategy would be of interest.