Neely Hines MD, Presenter: Nothing to Disclose

George Lantos MD, Abstract Co-Author: Nothing to Disclose

Murray Wittner MD, Abstract Co-Author: Nothing to Disclose

Herbert Tanowitz MD, Abstract Co-Author: Nothing to Disclose

Christina Coyle MD, Abstract Co-Author: Nothing to Disclose

Edema surrounding calcified brain lesions in the setting of seizures and other symptoms in neurocysticercosis has been observed in several studies. We sought to determine whether these findings were applicable to a population of neurocysticercosis patients in an urban setting in the United States. Further, we wanted to confirm the findings that calcified brain lesions with surrounding edema in this population correlated with symptoms.

We retrospectively reviewed the imaging studies on our neurocysticercosis patients. Of the 71 patients seen in our tropical medicine clinic over an 8 year period, 18 (25%) had calcifications on CT. Of these 18, 7 had edema around a calcified lesion at some point during their course. All 7 patients had seizures at presentation as well as other complaints including dizziness and headache. Of these 7 patients, 6 were male, compared to 43 of all 71. The mean age of patients was 32 +/- 9 years. Four patients were immigrants from Mexico, 2 from the Dominican Republic, and 1 was US born and had traveled to India. Immunoblot for neurocysticercosis was positive in 4 of the 7 patients. In 3 patients, the diagnosis was made by very typical features on sequential studies.

All 7 patients had symptoms when MRI revealed edema, 4 of whom had seizures concurrent with edema. The others had dizziness, aphasia and arm numbness. All 7 had follow up imaging showing resolution of the edema without steroids or cysticidal treatment, with a mean time to resolution of 3 months.

Prior studies of patients from Peru or selected referred patients to the NIH have found edema and symptoms related to calcified lesions in 34.5% of patients. This study shows that the phenomenon occurs at a similar rate and correlates with symptoms in an unselected urban clinic population. It is unknown whether the edema is due to an inflammatory response to release of antigen, whether seizures cause the edema, or a combination. Radiologists need to be aware of this finding as additional understanding will require increased recognition of this phenomenon.

Calcified neurocysticercosis lesions are not inert as surrounding edema is common and correlates with symptoms.

Hines, N, Lantos, G, Wittner, M, Tanowitz, H, Coyle, C, Edema Near Calcified Neurocysticercosis Lesions: Further Observations.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4440559.html