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From the Department of Neurological Sciences (Dr. Del Brutto), Hospital–Clinica Kennedy, Guayaquil, Ecuador; the Department of Neurological Sciences (Dr. Rajshekhar), Christian Medical College and Hospital, Vellore, India; the Infectious Disease Section (Dr. White), Department of Medicine, Baylor College of Medicine, Houston, TX; the Division of Parasitic Diseases (Drs. Tsang and Schantz), National Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA; the Laboratory of Parasitic Diseases (Dr. Nash), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD; the Department of Neurology (Dr. Takayanagui), Faculty of Medicine of Ribeirao Preto, University of Sao Paolo, Brazil; the University of Cambridge Clinical School (Dr. Evans), Cambridge, UK; the Instituto de Diagnóstico y Referencia Epidemiológicos (Drs. Flisser and Correa) and Dirección General de Epidemiología (Dr. Sarti), Secretaría de Salud, Mexico DF, Mexico; the Instituto Colombiano de Medicina Tropical (Dr. Botero), Medellín, Colombia; Pfizer Global Research and Development (Dr. Allan), Sandwich, UK; the Universidad Nacional Mayor de San Marcos de Lima (Dr. Gonzalez), Perú; the Asociación Benéfica, Proyectos en Informática, Salud, Medicina y Agricultura (Drs. Gonzalez, Gilman, and García), Lima, Perú; the Department of International Health (Dr. Gilman), The Johns Hopkins University, School of Hygiene and Public Health, Baltimore, MD; and the Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, and the Departments of Microbiology and Pathology, Universidad Peruana Cayetano Heredia (Drs. Gilman and García), Lima, Perú.
Address correspondence and reprint requests to Dr. Oscar H. Del Brutto, Air Center 3542, PO Box 522970, Miami, FL 33152-2970; e-mail: odbrutto{at}telconet.net
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.
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