Neurocysticercosis. Review of the literature and long term follow up of two distinct Germany cases

Neurocysticercosis, caused by Taenia solium larvae (cysticerci), is the mos t common parasitic infection of the human CNS Worldwide. In Germany its app earance is rare. Here we report two cases of neurocysticercosis which we fo llowed over a period of 4-6 years. The first patient acquired neurocysticer cosis in Germany. On admission he suffered from papilledema, partial seizur es and a mild psychotic disorder. MR-tomography showed an internal hydrocep halus and multiple contrast enhancing parenchymal cysts. In the course of t he disease a giant cyst within the left temporal pole developed and was exs tirpated neurosurgically. The persistent internal hydrocephalus required ve ntriculoperitoneal shunting. Therapy with Praziquantel led to a clinical im provement, however, repeated analysis of the cerebrospinal fluid documented peristent inflammation. With the aid of a contrast enhanced three-dimensio nal (3D) ultrasound imaging technique we demonstrated increased cerebral pe rfusion surrounding one cyst. This may be interpreted as evidence for persi stent disease activity. The second patient presented with repeated episodes of cysticercotic encephalitis, which is rarely described in the literature (incidence 1%). Clinical features, laboratory findings, diagnosis, and the rapy of neurocysticercosis will be presented together with the pitfalls of the two described cases. Our cases will be compared to previous reports on clinical findings in neurocysticercosis.