A 54-year-old man from rural China presented with a 4-month history of proximally progressive weakness in the left upper limb, where diminished strength and hyperreflexia were noted. Head MRI showed a 5.5 × 4.8 × 4.6-cm right frontoparietal septate cyst with an enhancing mural nodule (Figure 1, A–C). CT revealed foci of calcification (Figure 1D). Diagnosis of neurocysticercosis was suspected, given the imaging findings suggesting a loculated cysticercus containing calcification and an enhancing scolex. Of interest, ELISA-based detection of cysticercus-specific antibodies in the CSF was unremarkable. CSF protein and cell count were also normal. During exploratory surgery, clear fluid with yellow nodules and daughter cysts was removed from the subarachnoid cyst, revealing foci of granulomatous inflammation on brain parenchyma (Figure 2). Pathologic examination identified Taenia solium larvae (eFigure 1, links.lww.com/WNL/C956). Giant subarachnoid cysticerci over the cerebral convexities are very rare.1 Absence of CSF antibodies in patients with radiographic findings suggestive of subarachnoid neurocysticercosis should not preclude its diagnosis.2
Axial (A), sagittal (B), and coronal (C) views of contrast-enhanced T1-weighted MRI showed a cystic lesion with nodular enhancement (red arrowheads) and internal septation (white arrowheads). Note the mass effect evidenced by a slight midline shift. (D). Nonenhanced CT showed eccentric foci of calcification (yellow arrowhead).
(A) A cyst of high pressure was readily visualized on opening of the dura. (B) Nodular contents and daughter cysts were extracted from within. (C) One daughter cyst was sent for pathologic examination. (D) Foci of granulomatous inflammation (blue arrowheads) were noted on adjacent brain parenchyma.
Author Contributions
Z. Qian: drafting/revision of the article for content, including medical writing for content; major role in the acquisition of data; study concept or design; and analysis or interpretation of data. Z. Li: drafting/revision of the article for content, including medical writing for content; major role in the acquisition of data; study concept or design; and analysis or interpretation of data. Z. Zhang: drafting/revision of the article for content, including medical writing for content; major role in the acquisition of data; and analysis or interpretation of data. J. Chen: drafting/revision of the article for content, including medical writing for content; major role in the acquisition of data; and analysis or interpretation of data. X. Chen: drafting/revision of the article for content, including medical writing for content; major role in the acquisition of data; and study concept or design. J. Gao: drafting/revision of the article for content, including medical writing for content; major role in the acquisition of data; study concept or design; and analysis or interpretation of data.
Study Funding
This work was funded by the National High-Level Hospital Clinical Research Funding (2022-PUMCH-B-112) and CAMS Innovation Fund for Medical Sciences (2021-I2M-C&T-B-016).
Disclosure
Z. Qian, Z. Li, Z. Zhang, J. Chen, and X. Chen report no disclosures relevant to the manuscript. J. Gao received fundings from the National High-Level Hospital Clinical Research Funding (2022-PUMCH-B-112) and CAMS Innovation Fund for Medical Sciences (2021-I2M-C&T-B-016) for this work. Go to Neurology.org/N for full disclosures.
Acknowledgment
The authors thank the patient for participating in this study.
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Resident and Fellow Section Editor Whitley Aamodt, MD, MPH.
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- Received January 15, 2023.
- Accepted in final form May 3, 2023.
- © 2023 American Academy of Neurology
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