336 - Neurocysticercosis in a non-endemic region: A large case series from New York City

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Presenting Author(s)

Cesar G. Berto

MD
Jacobi Medical Center
Bronx, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

Christina Coyle

Professor
Albert Einstein College of Medicine
Bronx, NY
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Neurocysticercosis (NCC) is associated with significant morbidity and a variety of clinical presentations We describe our experience with NCC at a New York City hospital.

Methods: A retrospective review of consecutive patients with a confirmed diagnosis of neurocysticercosis who attended to Jacobi Medical Center in New York City was done. Demographic data, symptoms at presentation, and cysticercosis serology were retrieved from the medical records. The cases were classified according to the location of the cysts. Demographic and clinic variables were compared to assess for differences according to the cyst location.

Results:

A total of 260 cases of NCC were included. Of these cases, 163 (62.7%) were male, and the median age was 36.7 ± 13.7 years. A total of 245 patients (94.2%) were immigrants from 22 different countries. The most common countries of origin were Mexico (28.8%) and Ecuador (24.2%). Parenchymal NCC alone was seen in 139 patients (53.5%); of these, 31 patients had viable cysts. Forty patients (15.4%) were diagnosed with subarachnoid NCC (SANCC) alone and 19 patients (7.3%) had intraventricular NCC alone. Sixty-two patients (23.8%) had parenchymal and extra parenchymal NCC. Additionally, 24.7% of SANCC cases had concomitant spinal NCC. The median time from immigration to presentation was 9.5 years. SANCC cases had significantly longer time from immigration than parenchymal disease. The most common symptom among patients with only parenchymal NCC was seizures (68.4%). Among patients with only SANCC, 28 patients (70.0%) reported headache. Fifteen patients (37.5%) had intracranial hypertension and 12 required shunt placement. Eight patients (20.0%) of the SANCC group presented as an ischemic event. Cysticercus antigen was measured in 172 patients and was positive in 38 patients (14.6%); all but one with a positive antigen had extra-parenchymal NCC.

Conclusion:

This is the largest series of NCC reported in the US and highlights the importance of SANCC disease, a more severe form of NCC. Our data suggests that those with SANCC present with intracranial hypertension and have longer latency than other forms. The NCC recombinant antigen was more likely to be positive in extra-parenchymal disease. This is a complex disease and ID physicians should be aware of the many presentations.