Cysticercosis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Presenting symptoms differ according to the site of the cysticerci. Parenchymal neurocysticercosis causes all the symptoms and signs of space occupying lesions. Extraparenchymal neurocysticercosis causes manifestations of increased intracranial pressure if cysts are present in the subarachnoid space or in the ventricles, manifestations of spinal cord compression if present in the spinal cord or causes eye disease if cysts are present in the orbit.

Physical signs on neurological examion are highly variable and depend on the number, site, and size of the lesions:

• Motor impairment: Most common finding and can be in the form of hemiparesis or focal motor deficit.
• Sensory deficit
• Decreased level of consciousness
• Speech and language deficits
• Cerecellar and extrapyramidal deficits

1. Ocular cysticercosis:

• Symptoms depend on the exact site of infestation in the eye.
• Retinal and subretinal infestation have the worst prognosis and are the most difficult to treat.

2. Extraparenchymal in the brain ventricles and subarachnoid space:

Signs of increased intracranial pressure:

• Papilledema
• High opening pressure on lumbar puncture
• In advanced cases: reflex bradycardia and decreased level of consciousness

3. Spinal cord cysticercosis:

It is very rare (1.5-3% of all the cases).^[1]The presentaion depends on the site of the lesion.

• Paralysis of limbs below the level of compression
• Decreased sensation below the level of compression
• Lhermitte’s sign (intermittent shooting electrical sensation)
• Hyperreflexia may be present.
• Babinski sign positive

• Muscular pseudohypertrophy, which presents with muscle swelling
• Muscular atrophy and fibrosis at later stage

• Subcutaneous cysts are in the form of firm, mobile nodules, occurring mainly on the trunk and extremities.

• 
  Presence of a cysticercus, the larval form of the Taenia solium pork tapeworm in the pupil of this patient’s left eye. Although rare, cysticerci may float in the eye and cause blurry or disturbed vision. Infection in the eyes may cause swelling or detachment of the retina. From Public Health Image Library (PHIL). ^[2]

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