Q: 28 year old male student from Brazil, who visited his family during the months of summer is brought to ER with seizures. CT Head showed multiple cysts consistent with Neurocysticercosis (NCC). The patient was promptly treated with antiepileptics in ER and transferred to ICU. Following of which is recommended prior to the start of treatment for Neurocysticercosis (NCC)?

A) Test for latent Tuberculosis (TB)
B) screen for strongyloidiasis
C) Backup of Neurosurgical service
D) Ophthalmologic exam
E) All of the above



Answer: E

Treatment of NCC is multifacet and carries multiple challenges. Patients from the endemic area for NCC  also have high risks for latent TB and strongyloidiasis. As treatment of NCC also requires treatment with steroid along with antiparasitics, it is recommended to check for latent TB. Also, treatment of NCC may cause dissemination of strongyloidiasis, which may require treatment prior to NCC. Multiple cysts in the brain carry the risk of hydrocephalus with the treatment of NCC and may require ventriculostomy.  Similarly, initiation of the treatment of NCC may cause chorioretinitis, retinal detachment, or vasculitis, due to massive inflammation from the breakdown of cellular walls of parasites. Proper ocular exam is required as surgical intervention may be needed to remove ocular cysts, prior to antiparasitic treatment.