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Neurological picture
Disseminated cysticercosis
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  1. A I BHIGJEE
  1. Department of Neurology
  2. Department of Radiology, University of Natal, South Africa
  1. Professor A I Bhigjee, Department of Neurology, Wentworth Hospital, Private Bag, Jacobs 4026, South Africa.
  1. C SANYIKA
  1. Department of Neurology
  2. Department of Radiology, University of Natal, South Africa
  1. Professor A I Bhigjee, Department of Neurology, Wentworth Hospital, Private Bag, Jacobs 4026, South Africa.

http://dx.doi.org/10.1136/jnnp.66.4.545

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    A 24 year old man presented with a 3 month history of seizures. He was well built with large muscles and had multiple subcutaneous nodules. This combination of findings (figure, A and B) led to the the clinical diagnosis of disseminated cysticercosis.

    MRI of the brain and muscles showed a myriad of cysticerci (figure, A, B, and C). (A) Note the enlarged muscles and the subcutaneous nodules (arrows). (B) The arrows indicate nodules in the anterior chest wall. (B) Brain MRI with contrast. (C) Multiple cysticerci noted. Some show enhancement indicating dying cysts. (D) Note the cysticerci in the cervical muscles. (E) T2 weighted MRI of the thigh muscles. Numerous cysticerci are present.

    They were hypointense on T1 and hyperintense on T2. There were cysts in the neck, tongue, and all limbs. No cysts were present in the heart. Cysticercus enzyme linked immunosorbent assay (ELISA) on CSF was strongly positive.

    The seizures were controlled on 300 mg phenytoin daily. The patient had an uneventful course of prednisone and albendazole.