Patient: [Patient Name]
MRN: [Medical Record Number]
Date: [Date of Encounter]
Chief Complaint:
(Depends on presentation) Seizures, headaches, focal neurological deficits
(weakness, speech impairment, vision changes), cognitive decline, new-onset
mental status changes.
History of Present Illness:
Onset, duration, and frequency of any presenting symptoms.
Seizure description (if present): Type (e.g., focal, generalized), aura (warning symptoms before a seizure), duration, postictal state (confusion
after a seizure).
Character and location of headaches (if present).
Description of any focal neurological deficits (weakness, numbness, vision changes, speech difficulties).
Recent history of travel to endemic areas (regions with high prevalence of Taenia solium infection).
Past medical history of seizures or other neurological conditions.
Past Medical History:
Underlying medical conditions (e.g., hypertension, diabetes).
History of immunosuppression (e.g., HIV/AIDS, medications).
Social History:
Residence history (travel to endemic areas).
Pork consumption (exposure to T. solium eggs).
Family History:
No familial association with neurocysticercosis.
Physical Exam:
General examination: Assess for fever, signs of increased intracranial pressure (papilledema on fundoscopic exam).
Neurological examination: Evaluate mental status, cranial nerves, motor function, sensory function, coordination, and reflexes. Focal deficits may
be present depending on the location of the cysts.
Laboratory Tests:
Complete blood count (CBC): May show eosinophilia (increased eosinophils) in some cases.
Serum electrolytes: May be deranged if there is significant intracranial hypertension.
Cysticercosis serological tests: ELISA or immunoblot tests can detect antibodies against the T. solium parasite. However, these tests can have limitations in sensitivity and specificity.
Imaging Studies:
Neuroimaging (essential for diagnosis):
Head CT scan: May show calcified lesions (characteristic finding in late stages) but may miss active lesions.
Brain MRI with contrast: More sensitive than CT scan for detecting active cysts and their location (parenchymal, meningeal, ventricular).
Assessment:
Neurocysticercosis (suspected or confirmed): Based on clinical presentation (seizures, focal neurological deficits), travel history, and supportive findings on neuroimaging.
Stage of disease: Can be classified as active (with viable cysts) or inactive (calcified lesions).
Cyst location (single/multiple, parenchymal/meningeal/ventricular):
Impacts clinical presentation and treatment approach.
Intracranial pressure: Assess for signs and symptoms suggestive of increased intracranial pressure.
Differential Diagnoses:
Consider other causes of seizures, focal neurological deficits, and intracranial hypertension, depending on the presentation:
Epilepsy (other causes)
Brain tumors
Stroke
Meningitis
Abscess
Plan:
Treatment aims to address active cysts, manage symptoms (seizures, headaches), and prevent complications (hydrocephalus, increased intracranial pressure). Possible elements include:
Antiparasitic medications: Albendazole or praziquantel to kill the parasite within the cysts.
Anticonvulsant medications: To control seizures if present.
Corticosteroids: To reduce inflammation around the cysts and manage symptoms of increased intracranial pressure.
Surgical intervention: May be considered for large cysts causing mass effect or hydrocephalus.
Supportive care: Pain management, management of raised intracranial pressure.
Consultations: Consider referral to an infectious disease specialist
and/or a neurologist experienced in managing neurocysticercosis.
Prognosis:
The prognosis depends on the severity of the infection, cyst location, and prompt diagnosis and treatment. Early treatment can improve the outcome and prevent complications.
Follow-up:
Regular follow-up appointments to monitor response to treatment, manage symptoms, and assess for complications.