Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 7  |  Issue : 4  |  Page : 519-521  

Intraventricular cysticercal cyst


Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India

Date of Web Publication25-Jun-2014

Correspondence Address:
Amit Agrawal
Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore - 524 003, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.135297

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  Abstract 

Due to the risk of acute obstructive hydrocephalus and mortality, intraventricular cysticercosis has been considered as a potentially life-threaten­ing emergency that needs an early diagnosis and urgent intervention. In the present article, we discuss the imaging findings in a case of intraventricular cysticercal cyst. Surgical removal of ventricular cysts and establishment of the normal cerebrospinal fluid (CSF) pathway is the mainstay of treatment, which can be best achieved by neuroendoscopy.

Keywords: Cysticercus cyst, hydrocephalus, intraventricular, lateral ventricular cyst, magnetic resonance imaging


How to cite this article:
Agrawal A, Rao G M. Intraventricular cysticercal cyst. Med J DY Patil Univ 2014;7:519-21

How to cite this URL:
Agrawal A, Rao G M. Intraventricular cysticercal cyst. Med J DY Patil Univ [serial online] 2014 [cited 2021 Sep 17];7:519-21. Available from: https://www.mjdrdypu.org/text.asp?2014/7/4/519/135297


  Introduction Top


Neurocysticercosis is caused by the larval form of the pork intestinal tapeworm, Taenia solium, and there is central nervous system (CNS) involvement in 60-90% of the infested patients. [1] Neurocysticercosis commonly involves the brain parenchyma, and intraventricular cysticercal cysts are seen in up to 20-50% of cases. [1] Due to the risk of acute obstructive hydrocephalus and mortality, intraventricular cysticercosis has been considered as a potentially life-threaten­ing emergency that needs an early diagnosis and urgent intervention. [2],[3],[4] In the present article, we discuss the imaging findings in a case of intraventicular cysticercal cyst.


  Case Report Top


A 16-year-old male child presented with the history of headache of 3 months duration. The headache became worse over the last 4-5 days and was associated with vomiting. One day before, he lapsed into altered sensorium. He had abnormal posturing of the body and high-grade fever. There was no past history of fever or seizures. At the time of presentation, the patient was in altered sensorium (GCS-E1V1M2), and the pupils were bilaterally constricted and reacting to light. He had fever of 101°F. Other general and systemic examination was unremarkable. The patient underwent urgent computed tomography (CT) scan brain and it showed asymmetrical dilatation of the lateral ventricles (left more than right), shift of septum pellucidum to the right, and an isodense rim in the left lateral ventricle [Figure 1]a. Magnetic resonance imaging (MRI) brain T1-weighted (T1W) image showed a well-defined ring-shaped lesion in the left lateral ventricle. The ring was isointense with an area of hyperintensity. The lesion was becoming hyperintense on T2-weighted (T2W) images and the hyperintense region was becoming isointense; on fluid-attenuated inversion recovery (FLAIR) images, the lesion was isointense to CSF and the ring was better visualized [Figure 1]a-f. The patient underwent endoscopic removal of the cyst and placement of external ventricular drain. Follow-up CT scan showed a decrease in the size of the ventricles and removal of the cyst [Figure 2]. The extraventricular drain was removed on the 4 th day. The patient received a course of albendazole.
Figure 1: (a) CT scan brain plain showing asymmetrical dilatation of the lateral ventricles (left more than right), shift of septum pellucidum to the right, and an isodense rim in the left lateral ventricle. (b) MRI brain T1W image showing well-defined ring-shaped lesion in the left lateral ventricle; the ring is isointense with an area of hyperintensity. (c) The lesion is becoming hyperintense on T2W images and the hyperintense region has become isointense now. (d) On FLAIR, the lesion is isointense to CSF and the ring is better visualized. (e) No restrction on diffusion sequence and (f) corresponding ADC image showing iso-intense scolex

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Figure 2: Postoperative CT scan showing resolution of the hydrocephalus (External ventricular drainage was clamped) and excision of the cyst

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  Discussion Top


The patients with intraventricular cysticercosis present with acute obstructive hydrocephalus and associated features, i.e. headache, vomiting, and altered sensorium. [2],[3],[4],[5] With the advancements in neuroimaging techniques, not only the diagnosis of these lesions has improved drastically but also it is possible to anticipate the accuracy about the diagnosis of neurocysticercosis by providing objective evidence on imaging. [5] On CT scan, the intraventricular lesions are isodense to CSF, and hence, it is difficult to visualize these lesions on CT alone. [6] MRI with cerebrospinal fluid (CSF) flow studies has been shown to be superior to CT alone as it permits demonstration of cystic lesions in greater detail. [7] On MRI, an intraventricular cyst can be suspected because of mass effect, ventricular obstruction, detection of a cyst rim, and/or CSF flow void adjacent to the rim. [5] Intraventricular cysticercal lesions produce signal intensities similar to those of CSF on both T1W and T2W images and may not be demonstrable on routine MR sequences. [5],[8] On T1W images, the cysts are gener­ally isointense to CSF and on T2W, they are isointense or hyperintense to CSF and the cyst wall and nodule (scolex) can also be seen in some patients. [8] As in the present case [Figure 1]d, MR FLAIR images can very well outline the cyst wall and the nodule. [8],[9],[10],[11] A number of cystic lesions including choroid plexus cyst, ependymal cyst, and colloid cyst need to be considered in the differential diagnosis of an intraventricular cyst. [6] Role of medical therapy is controversial; however, in cases of larger lesions or residual disease, a course of single (albendazole) or combined (albendazole + praziquantel) cysticidal drugs may be needed. [3],[12] Intraventricular cysticercosis has been recognized as one of the favorable forms of neurocysticercosis where a surgical excision is possible. [2],[3] Surgical removal of ventricular cysts and establishment of the normal CSF pathway is the mainstay of treatment, which can be best achieved by neuroendoscopy. [13] It is of utmost importance that the cysts in the third ventricle need to be removed without causing rupture. [3]

 
  References Top

1.Osborn AG, Salzman KL, Barkovich AJ. Diagnostic imaging: Brain: Salt Lake City: Amirsys; 2004.  Back to cited text no. 1
    
2.Bergsneider M, Holly LT, Lee JH, King WA, Frazee JG. Endoscopic management of cysticercal cysts within the lateral and third ventricles. J Neurosurg 2000;92:14-23.  Back to cited text no. 2
    
3.Rajshekhar V. Recurrent intraventricular cysticercal cyst. J Neurosci Rural Pract 2013;4:6.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.Cudlip SA, Wilkins PR, Marsh HT. Endoscopic removal of a third ventricular cysticercal cyst. Br J Neurosurg 1998;12:452-4.  Back to cited text no. 4
    
5.Kalra S, Jaiswal A, Behari S, Jain V. Lateral ventricular neurocysticercosis: A case report. Indian J Radiol Imaging 2006;16:775.  Back to cited text no. 5
  Medknow Journal  
6.Khandelwal M, Kumanova M, Gaughan JP, Reece EA. Role of diltiazem in pregnant women with chronic renal disease. J Matern Fetal Neonatal Med 2002;12:408-12.  Back to cited text no. 6
    
7.Rhee RS, Kumasaki DY, Sarwar M, Rodriguez J, Naseem M. MR imaging of intraventricular cysticercosis. J Comput Assist Tomogr 1987;11:598-601.  Back to cited text no. 7
    
8.Singh S, Gibikote SV, Shyamkumar NK. Isolated fourth ventricular cysticercus cyst: MR imaging in 4 cases with short literature review. Neurol India 2003;51:394-6.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
9.Zee CS, Segall HD, Boswell W, Ahmadi J, Nelson M, Colletti P. MR imaging of neurocysticercosis. J Comput Assist Tomogr 1988;12:927-34.  Back to cited text no. 9
    
10.Suss RA, Maravilla KR, Thompson J. MR imaging of intracranial cysticercosis: Comparison with CT and anatomopathologic features. AJNR Am J Neuroradiol 1986;7:235-42.  Back to cited text no. 10
    
11.Zee CS, Segall HD, Apuzzo ML, Ahmadi J, Dobkin WR. Intraventricular cysticercal cysts: Further neuroradiologic observations and neurosurgical implications. AJNR Am J Neuroradiol 1984;5:727-30.  Back to cited text no. 11
    
12.Bansal KK, Gupta C, Goel D, Singhal A, Bansal R. Giant fourth ventricular cyst: Diagnostic and therapeutic dilemmas. J Assoc Physicians India 2006;54:289.  Back to cited text no. 12
    
13.Ginier BL, Poirier VC. MR imaging of intraventricular cysticercosis. AJNR Am J Neuroradiol 1992;13:1247-8.  Back to cited text no. 13
    


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