Proposed diagnostic criteria for neurocysticercosis
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Abstract
Neurocysticercosis is the most common helminthic infection of the CNS but its diagnosis remains difficult. Clinical manifestations are nonspecific, most neuroimaging findings are not pathognomonic, and some serologic tests have low sensitivity and specificity. The authors provide diagnostic criteria for neurocysticercosis based on objective clinical, imaging, immunologic, and epidemiologic data. These include four categories of criteria stratified on the basis of their diagnostic strength, including the following: 1) absolute—histologic demonstration of the parasite from biopsy of a brain or spinal cord lesion, cystic lesions showing the scolex on CT or MRI, and direct visualization of subretinal parasites by funduscopic examination; 2) major—lesions highly suggestive of neurocysticercosis on neuroimaging studies, positive serum enzyme-linked immunoelectrotransfer blot for the detection of anticysticercal antibodies, resolution of intracranial cystic lesions after therapy with albendazole or praziquantel, and spontaneous resolution of small single enhancing lesions; 3) minor—lesions compatible with neurocysticercosis on neuroimaging studies, clinical manifestations suggestive of neurocysticercosis, positive CSF enzyme-linked immunosorbent assay for detection of anticysticercal antibodies or cysticercal antigens, and cysticercosis outside the CNS; and 4) epidemiologic—evidence of a household contact with Taenia solium infection, individuals coming from or living in an area where cysticercosis is endemic, and history of frequent travel to disease-endemic areas. Interpretation of these criteria permits two degrees of diagnostic certainty: 1) definitive diagnosis, in patients who have one absolute criterion or in those who have two major plus one minor and one epidemiologic criterion; and 2) probable diagnosis, in patients who have one major plus two minor criteria, in those who have one major plus one minor and one epidemiologic criterion, and in those who have three minor plus one epidemiologic criterion.
- Received December 6, 2000.
- Accepted March 3, 2001.
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Letters: Rapid online correspondence
- Proposed diagnostic criteria for neurocysticercosis
- Muralidhar K Katti, SCTI for Medical Sciences and Technology Trivandrum Indiasandi_moriarity@urmc.rochester.edu
Submitted November 14, 2001 - Reply to both Letters to the Editor
- Oscar H Del Brutto, Clinica Kennedy Guqyaqil Equadorsandi_moriarity@urmc.rochester.edu
Submitted November 14, 2001 - cysticercus granuloma versus tuberculoma
- Ravindra Kumar Garg, assistant professor, Department of Neurology, KGMC, Lucknow, Indiagarg50@yahoo.com
Submitted September 17, 2001
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