Table 4.

Clinical Pearls for Management of Neurocysticercosis

NCC includes a spectrum of diseases that differ in pathogenesis and optimal therapy. • Symptomatic therapya should be the focus of initial and emergency management. Antiparasitic treatment is important, but never an emergency. Parenchymal cystic NCC has better outcomes if treated with antiparasitic drugs along with corticosteroids. Subarachnoid NCC does not respond well to single antiparasitic drugs at doses and durations used for parenchymal NCC. Optimal management may require chronic anti-inflammatory therapy, intensive antiparasitic therapyb, and surgical therapyc. Ventricular NCC of the third and lateral ventricles should be treated with minimally invasive surgery when possibled, but minimally invasive and open craniotomies are options for fourth ventricular disease. Open craniotomy or CSF diversion along with antiparasitic drugs are optimal in select cases. Antiparasitic therapy should be deferred until after surgical therapy. Calcified lesions do not contain viable parasites and should not be treated with antiparasitic drugs.

Abbreviations: CSF, cerebrospinal fluid; NCC, neurocysticercosis.

^aSymptomatic therapy includes antiepileptic drugs for seizures, anti-inflammatory drug such as corticosteroids and methotrexate, and surgery for hydrocephalus.

^bAntiparasitic therapy for subarachnoid NCC may include prolonged courses of albendazole, high-dose albendazole, or combinations of praziquantel and albendazole.

^cSurgical therapy for subarachnoid NCC may include CSF diversion for hydrocephalus or minimally invasive surgical debulking.

^dAdherent cysticerci should be managed with CSF diversion along with antiparasitic drugs. Open craniotomy is effective for fourth ventricular lesions and the choice of approaches should depend on local surgical expertise.