Resolution of Arterial Stenosis in a Patient With Periarterial Neurocysticercosis Treated With Oral Prednisone

Abstract

Neurocysticercosis is the most common parasitic infection of the central nervous system. Neurovascular complications have been recognized as a frequent complication, with up to 10% of strokes in endemic areas being secondary to neurocysticercosis. We report a case of acute transient left hemichorea in an 11-year-old boy with cerebral cysticercosis involving the right middle cerebral artery. Brain magnetic resonance imaging (MRI) revealed T₂-weighted hyperintensity and gadolinium enhancement in the area surrounding the M1 segment of the right middle cerebral artery. Magnetic resonance angiography showed severe narrowing of the vessel at this site acutely. After treatment with a 1-month course of oral prednisone and initiation of aspirin, our patient had no recurrence of abnormal movements and follow-up magnetic resonance angiography and transcranial Doppler ultrasonography showed resolution of stenosis of the M1 segment.

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References

Sotelo J , Guerrero V , Rubio F : Neurocysticercosis: A new classification based on active and inactive forms. Arch Intern Med 1985;145:442–445.

Barinagarrementeria F , Del Brutto O : Lacunar syndrome due to neurocysticercosis. Arch Neurol 1989;46:415–417.

Del Brutto OH : Cysticercosis and cerebrovascular disease: A review. J Neurol Neurosurg Psychiatry 1992;55:252–254.

Earnest MP , Reller LB , Filley CM , Grek AJ : Neurocysticercosis in the United States: 35 cases and a review. Rev Infect Dis 1987;9:961–979.

Del Brutto OH , Sotelo J : Neurocysticercosis: An update. Rev Infect Dis 1988;10:1075–1087.

Torrealba G , Del Villar S , Tagle P , et al: Cysticercosis of the central nervous system: Clinical and therapeutic considerations. J Neurol Neurosurg Psychiatry 1984;47:784–790.

Alarcon F , Hidalgo F , Moncayo J , et al: Cerebral cysticercosis and stroke. Stroke 1992;23:224–228.

Barinagarrementeria F , Del Brutto O : Neurocysticercosis and pure motor hemiparesis. Stroke 1988;19:1156–1158.

Cantu C , Barinagarrementeria F : Cerebrovascular complications of neurocysticercosis: Clinical and neuroimaging spectrum. Arch Neurol 1996;53:233–239.

10.

McCormick GF , Zee CS , Heiden J : Cysticercosis cerebri: Review of 127 cases. Arch Neurol 1982;39:534–539.

11.

Carbajal JR , Palacios E , Azar-Kia B , Churchill R : Radiology of cysticercosis of the central nervous system including computed tomography. Radiology 1977;125:127–131.

12.

Rodriguez-Carbajal J , Del Brutto OH , Penagos P , et al: Occlusion of the middle cerebral artery due to cysticercotic angiitis. Stroke 1989;20:1095–1099.

13.

Grisolia JS , Wiederholt WC : CNS cysticercosis. Arch Neurol 1982;39:540–544.

14.

McCormick GF , Giannotta S , Zee C , Fisher M : Carotid occlusion in cysticercosis. Neurology 1983;33:1078–1080.

15.

Bickerstaff ER : Cerebral cysticercosis: Common but unfamiliar manifestations. BMJ 1955;1:1055–1058.

16.

White AC Jr : Neurocysticercosis: Updates on epidemiology, pathogenesis, diagnosis, and management. Annu Rev Med 2000;51:187–206.

17.

Bang OY , Heo JH , Choi SA , Kim DI : Large cerebral infarction during praziquantel therapy in neurocysticercosis. Stroke 1997;28:211–213.

18.

Woo E , Yu YL , Huang CY : Cerebral infarct precipitated by praziquantel in neurocysticercosis—A cautionary note. Trop Geogr Med 1988;40:143–146.

19.

Wilson M , Bryan RT , Fried JA , et al: Clinical evaluation of the cysticercosis enzyme-linked immunoelectrotransfer blot in patients with neurocysticercosis. J Infect Dis 1991;164:1007–1009.

20.

Rosenfeld E : Neurocysticercosis update. Pediatr Infect Dis J 2003;22:181–182.

21.

Aguilar-Rebolledo F , Meza-Lucas A , Torres J , et al: Evaluation of the enzyme-linked immunoelectrotransfer blot assay for diagnosis of neurocysticercosis in children. J Child Neurol 2002;17:416–420.

22.

Cantu C , Villarreal J , Soto JL , Barinagarrementeria F : Cerebral cysticercotic arteritis: Detection and follow-up by transcranial Doppler. Cerebrovasc Dis 1998;8:2–7.