Reactivation of neurocysticercosis: calcified nodular lesion and perilesional edema

A 53-year-old man presented to the emergency department with headache and seizures. Axial fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) revealed a nodular focus in the right temporal lobe with a halo of T2 hyperintensity (Figure A). Computed tomography (CT) confirmed a calcified image with edema (Figure B). The patient's symptoms improved with clinical treatment, and CT after 7 months showed maintenance of cerebral calcification with the disappearance of edema, suggesting total regression of the inflammation (Figure C). Neurocysticercosis (NCC) develops after the ingestion of Taenia solium eggs and represents the parasitic disease with the greatest tropism for the human central nervous system¹. It is the most prevalent cause of acquired epilepsy and is a major public health problem worldwide^1,2. Calcifications, which represent the final stage, are the most common radiological findings among NCC cases. The presence of perilesional edema around a calcification supports the diagnosis of NCC reactivation, which can lead to headaches, seizures, and disabling epilepsy^2,3. Some hypotheses can explain the reactivation of the disease. For example, perilesional edema may have resulted from the death of parasites that were still viable and incompletely calcified^2,3. Another possibility is the release of antigens from dead cysticerci, which, for unclear reasons, can be recognized by the host, triggering an inflammatory response². Regardless of the explanation, clinicians and radiologists should know that patients with calcified lesions may experience NCC reactivation². Thus, this diagnosis should be made using imaging findings, and prompt care support must be provided to avoid unfavorable outcomes.

ACKNOWLEDGMENTS

We offer our deepest thanks to the institutions that provided technical support for the development and implementation of this study.

REFERENCES

• ¹
  Kimura-Hayama ET, Higuera JA, Corona-Cedillo R, Chávez-Macías L, Perochena A, Quiroz-Rojas LY, et al. Neurocysticercosis: radiologic-pathologic correlation. Radiographics. 2010;30(6):1705-19.
• ²
  Coeli GNM, Tiengo RR, Silva AC, Fernandes JOM, Silva GC, Silva LUMA. Neurocisticercose nodular calcificada com sinais de reativação. Radiol Bras. 2012;45(5):291-3.
• ³
  Lino-Junior RS, Faleiros ACG, Vinaud MC, Oliveira FA, Guimarães JV, Reis MA, et al. Anatomopathological aspects of neurocysticercosis in autopsied patients. Arq Neuropsiquiatr. 2007;65(1):87-91.

• All the authors take full responsibility for the data, the analyzes, interpretation and the conduct of the research, for full access to all the data and the right to publish any and all of them.

Publication Dates

• Publication in this collection
  25 Feb 2022
• Date of issue
  2022

History

• Received
  28 Oct 2021
• Accepted
  09 Dec 2021