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Edema associated with calcified lesions in neurocysticercosis

From the Laboratory of Parasitic Diseases, National Institutes of Allergy and Parasitic Diseases (Dr. Nash), and the Warren Grant Magnuson Clinical Center, Diagnostic Radiology Department (Dr. Patronas), National Institutes of Heath, Bethesda, MD.

Address correspondence and reprint requests to Dr. Theodore Nash, National Institutes of Health, Laboratory of Parasitic Diseases, Building 4, Room B1-06, Bethesda, MD 20892; e-mail: tnash{at}atlas.niaid.nih.gov

OBJECTIVE: To determine serial MRI and CT abnormalities around calcified cysts due to cysticercosis in previously treated patients during periods of seizure activity.

BACKGROUND: Some patients with calcified lesions due to cysticercosis have seizures. How and why seizures occur in this setting are unknown.

METHODS: Three patients with known, treated cysticercosis were studied prospectively by serial MRI and CT before, during, and after seizure activity.

RESULTS: All three patients demonstrated edema surrounding calcified lesions. Two of three patients had repeated episodes involving the same calcified lesions, and their symptoms corresponded to the location of the lesion. Enhancement was present in the lesions demonstrating edema, but was also present surrounding other nonsymptomatic calcified lesions.

CONCLUSIONS: Perilesional edema surrounding calcified lesions due to cysticercosis occurs in some patients at the time of seizure activity. Repeated seizure episodes tend to be associated with the same lesions. Although the mechanisms involved are unknown, long-term antiseizure medication is likely indicated in these patients. Current evidence does not support the use of specific antiparasitic treatment in these patients.

Key words: Cysticercosis—Seizure—Taenia solium—MRI.

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