Cerebrovascular complications of neurocysticercosis. Clinical and neuroimaging spectrum

C. Cantu and F. Barinagarrementeria
Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico.

OBJECTIVE: To describe the clinical and neuroimaging spectrum of cerebral Cysticercus arteritis to clarify the mechanisms of a stroke that is associated with neurocysticercosis. DESIGN: Case series. SETTING: Tertiary care center. PATIENTS: Sixty-five patients with strokes that were associated with neurocysticercosis. Based on the extension of cysticercosis, the study group was divided into patients with focal or diffuse cysticercal disease. Patients with focal affection were subdivided into those with small- and large-vessel angiitis. MEASURES: For each group. stroke syndromes, mode of onset, associated neurologic syndromes, neuroimaging features of cysticercosis and cerebral infarcts, angiographic and cerebrospinal fluid findings, and outcome were analyzed. RESULTS: Thirty-five patients had focal cysticercosis (13 with small-and 22 with large-vessel angiitis), and 30 had diffuse disease with either small-or large-vessel involvement. A high frequency of subarachnoidal cysts was found, neighboring the ischemic area. Patients with focal cysticercosis has a vascular onset in 80% compared with 20% in those with diffuse cysticercosis (P<.001). Distinctive findings in diffuse cysticercosis were hydrocephalus (80%), multiple cerebral infarcts (64%), and mental disorders (43%) (P<.001). There was a close parallelism between the type of cysticercosis and the degree of cerebrospinal fluid inflammatory changes, reflecting in the outcome. Death or incapacitating sequelae were associated with diffuse cysticercosis, and total recovery was common in patients with focal disease and small-vessel angiitis, whereas intermediate morbimortality occurred with focal cysticercosis and large-vessel vasculitis. CONCLUSION: Based on the distribution of cysticercal disease and the severity of concomitant chronic arachnoiditis, it is possible to identify a wide spectrum of cerebrovascular involvement caused by neurocysticercosis.