Neurocysticercosis: Updates on epidemiology, pathogenesis, diagnosis, and management

Neurocysticercosis is now recognized as a common cause of neurologic diseas e in developing countries and the United States. The pathogenesis and clini cal manifestations vary with the site of infection and accompanying host re sponse. Inactive infection should be treated symptomatically. Active parenc hymal infection results from an inflammatory reaction to the degenerating c ysticercus and will also respond to symptomatic treatment. Controlled trial s have not demonstrated a clinical benefit for antiparasitic drugs. Ventric ular neurocysticercosis often causes obstructive hydrocephalus. Surgical in tervention, especially cerebrospinal fluid diversion, is the key to managem ent of hydrocephalus. Shunt failure may be less frequent when patients ape treated with prednisone and/or antiparasitic drugs. Subarachnoid cysticerco sis is associated with arachnoiditis. The arachnoiditis may result in menin gitis, vasculitis with stroke, or hydrocephalus. Patients should be treated with corticosteroids, antiparasitic drugs, and shunting if hydrocephalus i s present.