Neurology: Case of the Month

Test Yourself — Patient 10

Neurocysticercosis (NCC)

1. The most common clinical presentation of patients with NCC is which of the following:
   • [ A ] Muscle cramping and proximal weakness.
   • [ B ] Low grade fever with intermittent spikes greater than 100 degrees F.
   • [ C ] Seizures.
   • [ D ] An intermittent rash that most often involves the face and thorax.
2. All of the following would be typical of CSF findings in a patient with NCC EXCEPT:
   • [ A ] Elevation of protein.
   • [ B ] Lymphocytic pleocytosis.
   • [ C ] Eosinophilia and decreased glucose.
   • [ D ] Monoclonal gammopathy.
3. All of the following are true regarding therapy of NCC EXCEPT
   • [ A ] Shunt placement may be required.
   • [ B ] Albendazole is usually given in combination with steroids.
   • [ C ] Drug therapy is less effective for chronic arachnoiditis, extraparenchymal lesions, and calcified cysts.
   • [ D ] Worsening of symptoms may occur 2-3 days after treatment with praziquantel.
4. The typical appearance on MRI in NCC includes all of the following EXCEPT
   • [ A ] Cyst wall enhancement and surrounding edema may be seen when the cyst fluid becomes turbid, the wall thickens, and the scolex begins to calcify.
   • [ B ] The MRI is unable to detect the grapelike clusters of cysts when they occur in the subarachnoid space.
   • [ C ] When the cyst contracts and the scolex becomes more calcified, the lesion may be iso-to hypointense with surrounding edema and gadolinium enhancement.
   • [ D ] When the lesion is totally calcified, the edema and enhancement may disappear.
5. All of the following statements are true regarding NCC EXCEPT
   • [ A ] Can present with multiple cystic lesions in the basilar cisterns and induce hydrocephalus.
   • [ B ] Severe cases are nearly always serum and CSF positive.
   • [ C ] Cysts may be entrapped in the ventricles, most commonly the third ventricle.
   • [ D ] Spilling of cyst contents can cause severe meningeal inflammation.

 

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