Images in clinical tropical medicine: disseminated cysticercosis.

A 17-year-old boy from a northern Indian village presented with recurrent episodes of secondarily generalized tonic-clonic seizures since 12 years of age. He had been diagnosed earlier as cysticercotic encephalitis ( Figure 1 ) with features of intracranial hypertension. Despite being on dexamethasone (8 mg/d) and adequate doses of three anti-epileptic drugs (valproic acid 1250 mg/d; phenytoin 300 mg/d; and clobazam 20 mg/d), he continued to have one to two seizures every month. He denied consumption of pork. Magnetic resonance imaging of the head, done 4 months later, revealed innumerous viable cysticerci containing clear fluid and a scolex (“hole-with-dot” sign 1 ) in the brain parenchyma, scalp and facial muscles, and the tongue ( Figure 2 ). No inflammation was evident around the cysts, on imaging. Two translucent subconjuctival cysts containing a buffcolored scolex were present in his left eye ( Figure 2 ). No focal neurologic deficit was apparent. Funduscopy was unremarkable. Treatment with cysticidal drugs, such as albendazole and praziquantel in patients with cysticercotic encephalitis, could precipitate a life-threatening elevation of the intracranial pressure and hence is contraindicated. 2 It remains unclear whether antiparasitic treatment can be given once the inflammation subsides. Cysticidal treatment was deferred in this patient, and anti-epileptic drugs alone were continued.