Experience with neurocysticercosis in the UK: correct diagnosis and neurosurgical management of the small enhancing brain lesion

Neurocysticercosis is a major cause of epilepsy and other neurological morb idity in endemic areas of the world but is exceptionally rare in the West. We have recently had experience of eight patients with this condition, seve n presenting with epilepsy and single or multiple small, enhancing parenchy mal lesions and one with hydrocephalus caused by a midbrain lesion. One les ion was stereotactically excised after it persisted, but in five other case s spontaneous cyst resolution was observed during expectant management with anticonvulsants. Two patients with multiple lesions were referred to us fo r further management but were free of active infection. Recent studies show that neurocysticercosis may often be diagnosed based upon the clinical, ep idemiological and radiological features. Spontaneous cyst resolution is to be expected in this condition and suspected patients should be carefully ob served and surgery avoided. We believe that this disease presents more comm only than has been appreciated in the UK and propose a protocol for managem ent.