TABLE 2.

Revised Del Brutto’s diagnostic criteria and degrees of diagnostic certainty for neurocysticercosis^a

Category	Criterion or definitionb
Diagnostic criteria
Absolute criteria	Histological demonstration of the parasite from biopsy specimen of a brain or spinal cord lesion
	Visualization of subretinal cysticercus
	Conclusive demonstration of a scolex within a cystic lesion on neuroimaging studies
Neuroimaging criteria
Major	Cystic lesions without a discernible scolex
	Enhancing lesionsc
	Multilobulated cystic lesions in the subarachnoid space
	Typical parenchymal brain calcificationsc
Confirmative	Resolution of cystic lesions after cysticidal drug therapy
	Spontaneous resolution of single small enhancing lesionsd
	Migration of ventricular cysts documented on sequential neuroimaging studiesc
Minor	Obstructive hydrocephalus (symmetric or asymmetric) or abnormal enhancement of basal leptomeninges
Clinical/exposure criteria
Major	Detection of specific anticysticercal antibodies or cysticercal antigens by well-standardized immunodiagnostic testsc
	Cysticercosis outside the central nervous systemc
	Evidence of a household contact with T. solium infection
Minor	Clinical manifestations suggestive of neurocysticercosisc
	Individuals coming from or living in an area where cysticercosis is endemicc
Degrees of diagnostic certainty
Definitive diagnosis	One absolute criterion
	Two major neuroimaging criteria plus any clinical/exposure criteria
	One major and one confirmative neuroimaging criteria plus any clinical/exposure criteria
	One major neuroimaging criteria plus two clinical/exposure criteria (including at least one major clinical/exposure criterion), together with the exclusion of other pathologies producing similar neuroimaging findings
Probable diagnosis	One major neuroimaging criteria plus any two clinical/exposure criteria
	One minor neuroimaging criteria plus at least one major clinical/exposure criteria

^aAdapted from reference 187 with permission of Elsevier.

^bDefinitions: cystic lesions, rounded, well-defined lesions with liquid contents of signal similar to that of CSF on CT or MRI; enhancing lesions, single or multiple, ring- or nodule-enhancing lesions of 10 to 20 mm in diameter, with or without surrounding edema, but not displacing midline structures; typical parenchymal brain calcifications, single or multiple solid lesions, most usually of <10 mm in diameter; migration of ventricular cyst, demonstration of a different location of ventricular cystic lesions on sequential CTs or MRIs; well-standardized immunodiagnostic tests, to date, antibody detection by enzyme-linked immunoelectrotransfer blot assay using lentil lectin purified T. solium antigens and detection of cysticercal antigens by monoclonal antibody-based ELISA; cysticercosis outside the central nervous system, demonstration of cysticerci from biopsy of subcutaneous nodules, X-ray films, or CT showing cigar-shape calcifications in soft tissues, or visualization of the parasite in the anterior chamber of the eye; suggestive clinical manifestations, mainly seizures (often starting in individuals aged 20 to 49 years; the diagnosis of seizures in this context is not excluded if patients are outside the typical age range), but other manifestations include chronic headaches, focal neurologic deficits, intracranial hypertension, and cognitive decline; area of cysticercosis endemicity, a place where active transmission is documented.

^cOperational definition.

^dThe use of corticosteroids makes this criterion invalid.