Thirty-six patients with subarachnoid and intraventricular cysticercosis were randomly assigned to receive albendazole at 15 or 30 mg/kg/day plus dexamethasone for 8 days. Results favored a higher dose, with larger cyst reduction on MRI at 90 and 180 days and higher albendazole sulfoxide levels in plasma. An albendazole course at 30 mg/kg/day combined with corticosteroids is safe and more effective than the usual dose. A single treatment was insufficient in intraventricular and giant cysts.

✓ In a prospective open study, 15 patients with hydrocephalus secondary to cysticercosis who required insertion of a ventriculoperitoneal (VP) shunt were treated with 50 mg of prednisone given orally three times a week. Treatment began in the 1st postoperative week, with isoniazid and pyridoxine administered daily as antituberculous chemoprophylaxis. The drug regimen was continued with close follow up for 24 months. Clinical status, Karnofsky performance status (KPS) scores, and postoperative course in the prednisone-treated group were compared with 30 control patients with hydrocephalus due to cysticercosis. The control patients were matched by age and sex, underwent surgical shunting in the same period, and were followed routinely by the neurosurgery staff. Lumbar cerebrospinal fluid (CSF) was studied at 2, 16, and 32 weeks postoperatively in the prednisone group. At 24-month follow up two (13%) of 15 patients in the prednisone group and 18 (60%) of 30 patients in the control group required surgical shunt revisions for symptomatic shunt obstruction (p = 0.002). Follow-up studies of CSF performed at 32 weeks in the prednisone group revealed improvement of abnormal values with statistically significant differences for glucose (p < 0.02). Serial imaging studies in the prednisone group revealed persistence of cysticercal cysts with no change in size. Mean initial KPS scores were similar in both groups. At the end of the follow-up period, the mean KPS score was significantly higher in the prednisone group (p = 0.003). Prednisone and chemoprophylactic drugs were well tolerated. These results suggest that in selected patients with hydrocephalus secondary to cysticercosis, intermittent long-term prednisone therapy after VP shunting may reduce shunt malfunction and improve the functional status of the patients.

Background: Neurocysticercosis (NC) is one of the most frequent parasitic diseases of the central nervous system. Cysticidal drugs, albendazole and praziquantel, are generally effective when parasites localize in the parenchyma. In contrast, parasites lodged in the subarachnoid basal cisterns are less responsive to treatment.Case Presentation: The clinical and radiological pictures of six Mexican patients non-respondent to cysticidal treatment are presented.Conclusions: The possible factors involved in the cysticidal non-response are discussed and hints are provided of potentially useful changes to therapeutic protocols.

Objectives: To review neurological complications after the influenza A (H1N1) pdm09, highlighting the clinical differences between patients with post‐vaccine or viral infection.Design: A search on Medline, Ovid, EMBASE, and PubMed databases using the keywords “neurological complications of Influenza AH1N1” or “post‐vaccine Influenza AH1N1.”Setting: Only papers written in English, Spanish, German, French, Portuguese, and Italian published from March 2009 to December 2012 were included.Sample: We included 104 articles presenting a total of 1636 patient cases. In addition, two cases of influenza vaccine‐related neurological events from our neurological care center, arising during the period of study, were also included.Main outcome measures: Demographic data and clinical diagnosis of neurological complications and outcomes: death, neurological sequelae or recovery after influenza A (H1N1) pdm09 vaccine or infection.Results: The retrieved cases were divided into two groups: the post‐vaccination group, with 287 patients, and the viral infection group, with 1349 patients. Most patients in the first group were adults. The main neurological complications were Guillain‐Barre syndrome (GBS) or polyneuropathy (125), and seizures (23). All patients survived. Pediatric patients were predominant in the viral infection group. In this group, 60 patients (4.7%) died and 52 (30.1%) developed permanent sequelae. A wide spectrum of neurological complications was observed.Conclusions: Fatal cases and severe, permanent, neurological sequelae were observed in the infection group only. Clinical outcome was more favorable in the post‐vaccination group. In this context, the relevance of an accurate neurological evaluation is demonstrated for all suspicious cases, as well as the need of an appropriate long‐term clinical and imaging follow‐up of infection and post‐vaccination events related to influenza A (H1N1) pdm09, to clearly estimate the magnitude of neurological complications leading to permanent disability.

We report a case of a 32-year-old man who presented with subarachnoid hemorrhage. As revealed by lumbar puncture, the cerebrospinal fluid had low glucose, high protein levels, and pleocytosis with 5% of eosinophils. Cultures were negative. Enzyme-linked immunosorbent assay and complement fixation reactions for cysticercosis in cerebrospinal fluid were positive. An angiogram revealed an aneurysm of the right anteroinferior cerebellar artery. At surgery, the aneurysm was found to be surrounded by thickened leptomeninges, which histologically presented dense inflammation and remains of Cysticercus. The aneurysm could not be clipped, and it was wrapped. Postoperatively, the patient had dizziness and right ear tinnitus. He received prednisone therapy on alternate days and subsequently received albendazole for subarachnoid cysticerci. At the 4-year follow-up, the patient was asymptomatic and had normal cerebrospinal fluid. Although we cannot rule out a congenital aneurysm, its location inside an area of severe arachnoiditis around a cysticercus suggests an inflammatory origin. This type of vascular lesion not reported before should be suspected in patients with chronic cysticercotic meningitis.