351 - Neurocysticercosis: Clinical Experience in Large Urban Safety Net Hospital in Chicago

Background: Neurocysticercosis is a major cause of adult-onset epilepsy and premature death in adults. We aimed to describe the clinical and demographic features in a large patient population in Chicago of which published data is limited.

Methods: A retrospective chart search with ICD9/ICD10 diagnostic code for Neurocysticercosis and neuroimaging suggestive of Neurocysticercosis was performed for clinical encounters in the hospital or affiliated clinics between 2013-2018. After a careful chart review, patients who were clinically diagnosed with Neurocysticercosis were included in the study. A descriptive analysis of the data is presented.

Results: Out of a total of 90 patients all of whom were immigrants, the country of origin was reported in 60% and the majority were from Mexico (83.3%).  The mean age at the time of diagnosis was 32.3 years (median 29.5, range < 1 to 67). The most common presenting complaints were seizures (62.1%) and headache (27.6%). The most common type of seizure was generalized (48.8%) followed by focal (36.6%). Approximately a third of patients also had hydrocephalus (33.7%). Many patients had > 1 lesion on neuroimaging (70.7%) out of which the most common type were parenchymal lesions (60.9%) followed by ventricular and subarachnoid. Calcified (45.5%) and cystic lesions (44.2%) were found in about equal number of cases. A minority had both types of lesions (10.4%). Contrast enhancement or edema surrounding the lesion was found in about half (47.2%) of the cases. The number of years since the last visit to an endemic country before diagnosis was reported in 46.6% of cases and the mean was 9.8 years (range 0 to 30) and it was found that per year increase since the last visit increased the chance of having contrast enhancement/edema surrounding the lesion in neuroimaging or requiring treatment with antiparasitic medications. (OR 1.77 (1.08-2.90), P= 0.03).  

Conclusion: Our study agrees with previously reported data regarding seizure being the most common presenting complaint, generalized seizures being the most common type. The increasing risk of active lesions with increasing duration since the last visit to an endemic country raises the concern of clinically consequential delay in diagnosis.