Clinicopathological conference: Syncope and hemiparesis in a 38 year-old Ecuadoran man

The diagnosis of neurocysticercosis can be difficult. Serological examination, as done in the present case, can be helpful. Titers of ≥ 1:128 are usually significant, although negative results do not necessarily rule out infection. According to the Centers for Disease Control in Atlanta, of those individuals with seizures or intracerebral calcifications or both, only 50% will have diagnostic serum titers and they usually will have no antibodies in the CSF, whereas about 70% of those with meningeal involvement will have antibodies in both the serum and CSF. In patients with increased intracranial pressure 95% will have diagnostic serological titers in the serum and the CSF. Histological diagnosis of larval cestode infection is relatively straightforward although the precise taxonomic identification may require the help of an expert. Until recently, therapy for cysticercosis was limited to surgical intervention. However, medical treatment with praziquantel, a new class of acylated isoquinoline pyrazine antihelminthic, has been introduced and promises to be of major benefit in this infection. In the present case, after the patient recovered from surgery, further study indicated that other cysts, not amenable to surgical removal, remained. The patient subsequently was treated with praziquantel, 16.6 mg/kg 3 times a day for 14 days. Serological examination 2 years later showed a fall in antibody titer from >1:4096 to 1:64 in the serum and no reaction in the CSF, suggesting that medical therapy may have eliminated the remaining infection.