The medical treatment of 33 patients, 8 to 81 years (mean, 48y), with neurocysticercosis (NC) complicated by giant subarachnoid cysts (50mm or larger) and intracranial hypertension was evaluated at the Hospital de Especialidades, Mexico City. All received albendazole, 15mg/kg/d for 4 weeks, and dexamethasone. The treatment was repeated with a second course in one half the cases. Ten also received praziquantal 100mg/kg/day/4 weeks. Only 5 had undergone surgery for the cysts before receiving medical treatment. All patients showed improvement after a median follow-up of 59 months (range, 7 to 102 months), and the cysts had resolved or became calcified. Four required a further course of treatment. Anticonvulsant medications were continued in only 11 of 22 with a history of seizures. Ventriculoperitoneal shunt was performed in 15 patients with hydrocephalus. Sequelae from the cysts included optic atrophy, stroke, or diplopia in 4 patients. Medical treatment alone can be effective in the treatment of NC with giant subarachnoid cysts. Surgical removal of cysts is reserved for patients with life-threatening intracranial hypertension despite treatment with corticosteroids. [1]

COMMENT. Patients with neurocysticercosis with giant cysts who respond to corticosteroids or shunting should receive cesticidal drug treatment. The majority will respond to one or more courses of albendazole or praziquantal, and surgical removal of cysts may be necessary in a minority with persistent intracranial hypertension.

Human cysticercosis caused by the larvae of T solium is a leading cause of epilepsy in underdeveloped countries and is uncommon in the United States. Diagnosis of taeniasis is by demonstration of ova in feces or perianal swab. Diagnosis of neurocysticercosis is by head CT or MRI. An enzyme immunotransfer blot assay is available to detect antibody to T solium in serum or CSF. Treatment is individualized based on the viability of cysts. For patients with calcified nonviable cysts, symptomatic therapy with anticonvulsants and shunting for hydrocephalus are advised. For those with viable parenchymal cysts and inflammation, the role of antiparasitic drugs has not been firmly established. The use of antiparasitic drugs is favored by many clinicians, and the coadministration of corticosteroids for the first few days is recommended to decrease edema and adverse events. (American Academy of Pediatrics Red Book, 25th ed, 2000;pp560-562).