Presentation
Gradually increasing left-sided hearing loss for 6 months.
Patient Data
A multiloculated cystic lesion is seen involving the pons and the brachium pontis on the left side. The lesion extends into the 4th ventricle, where a membrane is seen, differentiating it from the CSF. There is mild upstream obstructive hydrocephalus and periventricular ooze. Internal contents are seen within the cyst in the pontine region. Enhancement is seen both peripherally and within the contents.
Another small lesion, best appreciated on diffusion and FLAIR, is seen in the Sylvian fissure on the right side.
There is enhancement of the intracanalicular portion of the 7th and 8th nerve complex on the left side, possibly indicative of meningeal spread of the disease process.
Case Discussion
Racemose neurocysticercosis is a rarer and lethal extraparenchymal form of neurocysticercosis. The disease is characterized by the involvement of the ventricles, subarachnoid (cisterns), and meninges.
Clinically, it presents with signs of raised intracranial pressure and hydrocephalus due to meningitis, adhesions, or free-floating cysts obstructing the flow of cerebrospinal fluid (CSF) 1.
On imaging, the cysts appear larger and multiloculated, and the scolices on their wall are usually absent in most racemose cases. The cysts follow CSF signal intensity and may show peripheral enhancement.
The most reliable test for the detection of specific Taenia solium antigens in serum or CSF is the EITB (enzyme-linked immunoelectrotransfer blot) 2 assay using lectin-purified glycoprotein extracts, with a sensitivity of 98% and a specificity of 100%.
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