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AJNR - American Journal of Neuroradiology

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Calcified Neurocysticercosis Lesions Trigger Symptomatic Inflammation During Antiparasitic Therapy

P. Poeschl^a, A. Janzen^a, G. Schuierer^b, J. Winkler^a, U. Bogdahn^a and A. Steinbrecher^a

^a Department of Neurology, University of Regensburg, Regensburg, Germany
^b Institute of Neuroradiology, District Hospital Regensburg, Universitätsstr 84, 93053 Regensburg, Germany

View larger version (90K): [in a new window]   Fig 1. Fluid-attenuated inversion recovery (FLAIR) imaging studies before therapy. Three of 11 cystic lesions are shown: living parasite in a right parietal cystic lesion (white arrow, A); another right parietal and a left parietal cortical cystic lesion (white arrows, B).

View larger version (149K): [in a new window]   Fig 2. Treatment response of the patient shown by MR imaging. Imaging was performed before treatment (A–C) and 10 days (D–F) and 3 months (G–I) after therapy. A–C, A small cystic right frontal lesion without contrast enhancement (A, B) or edema (white arrow, C) is seen; in the right perisylvian area, hypointense lesions medially (open triangle) and laterally to the right sylvian fissure are seen on fluid-attenuated inversion recovery (FLAIR) but not on T1-weighted images. D–F, Soon after therapy, ring enhancement (D, E) and edema (F) are detected in the right frontal lesion (white arrow); ring enhancement with severe edema is seen in the perisylvian lesions (open and white triangles; E, F). G–I, Three months after treatment, a slight enhancement (G, H) and edema (I) are still present frontally (white arrow); no lesion is seen in the perisylvian area (open and white triangles; H, I). A, D, G are T1-weighted images without contrast; B, E, H, T1-weighted images with contrast; and C, F, I, FLAIR images.

View larger version (77K): [in a new window]   Fig 3. CT scans obtained 3 months before therapy. The calcifications medially (triangle, A) and laterally (white triangle, B) to the right perisylvian fissure correspond to the perisylvian lesions shown in Fig 2 D–F. Note several calcifications not showing an inflammatory reaction after therapy (black arrows, A) and an additional right cerebellar lesion (white arrow, A).