Cysticercosis differential diagnosis: Difference between revisions

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__NOTOC__
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{{Cysticercosis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Cysticercosis]]
{{CMG}};{{AE}}{{AY}}
{{CMG}};{{AE}}{{AY}}


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* Presenting symptoms differ according to the site of the cysticerci.   
* Presenting symptoms differ according to the site of the cysticerci.   
* [[Parenchymal]] neurocysticerosis causes all the symptoms and signs of [[Space occupying lesion|space occupying lesions]].
* [[Parenchymal]] neurocysticercosis causes all the symptoms and signs of [[Space occupying lesion|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]].
* 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]].


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* [[Immunoblot|CDC's immunoblot]] is based on detection of [[antibody]] to one or more of [[Glycoprotein|7 lentil-lectin purified structural glycoprotein]] [[antigens]] from the larval cysts.
* [[Immunoblot|CDC's immunoblot]] is based on detection of [[antibody]] to one or more of [[Glycoprotein|7 lentil-lectin purified structural glycoprotein]] [[antigens]] from the larval cysts.
* It is 100% [[Specificity (tests)|specific]] and has a [[sensitivity]] superior to that of any other test yet evaluated
* It is 100% [[Specificity (tests)|specific]] and has a [[sensitivity]] superior to that of any other test yet evaluated
|[[Computed tomography|Computerized tomography (CT)]] is superior to [[magnetic resonance imaging|magnetic resonance imaging (MRI)]] for demonstrating small [[calcification]]s. However, [[MRI]] shows [[cysts]] in some locations (cerebral convexity, [[Ependyma|ventricular ependyma]]) better than [[CT]], is more [[Sensitivity|sensitive]] than CT to demonstrate surrounding [[cerebral edema|edema]], and may show internal changes indicating the death of cysticerci.
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* [[Computed tomography|Computerized tomography (CT)]] is superior to [[magnetic resonance imaging|magnetic resonance imaging (MRI)]] for demonstrating small [[calcification]]s.  
* However, [[MRI]] shows [[cysts]] in some locations (cerebral convexity, [[Ependyma|ventricular ependyma]]) better than [[CT]], is more [[Sensitivity|sensitive]] than CT to demonstrate surrounding [[cerebral edema|edema]], and may show internal changes indicating the death of cysticerci.
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|[[Brain abscess]]
|[[Brain abscess]]
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# Signs of [[increased intracranial pressure]]
# Signs of [[increased intracranial pressure]]
# [[Focal neurologic signs|Focal neurologic deficits]].
# [[Focal neurologic signs|Focal neurologic deficits]].
|[[TB|T.B.]] should be investigated everywhere else in the body (e.g. [[Lymphadenopathy|peripheral lymphadenopathy]], [[Sputum culture|sputum]] and [[blood culture]])
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* [[TB|T.B.]] should be investigated everywhere else in the body (e.g. [[Lymphadenopathy|peripheral lymphadenopathy]], [[Sputum culture|sputum]] and [[blood culture]])
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* [[CT]]: [[Contrast enhanced CT|Contrast-enhanced CT]] scan shows a ring enhancing lesion surrounded by an area of hypodensity ([[cerebritis]]) and the resulting [[mass effect]].
* [[CT]]: [[Contrast enhanced CT|Contrast-enhanced CT]] scan shows a ring enhancing lesion surrounded by an area of hypodensity ([[cerebritis]]) and the resulting [[mass effect]].
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|Neurosarcoidosis
|Neurosarcoidosis
|70% of the patients present with the neurological symptoms rather than the presentation of systemic disease. Common presentations are:<ref name="urlNeurosarcoidosis">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3975794/ |title=Neurosarcoidosis |format= |work= |accessdate=}}</ref>
|
 
* 70% of the patients present with the neurological symptoms rather than the presentation of systemic disease. Common presentations are:<ref name="urlNeurosarcoidosis">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3975794/ |title=Neurosarcoidosis |format= |work= |accessdate=}}</ref>
# Cranial nerve neuropathies: [[Facial palsy]] is the most common presentation.
# Cranial nerve neuropathies: [[Facial palsy]] is the most common presentation.
# [[Meningeal]] involvement: diffuse [[Meningitis|meningeal inflammation]] can cause diffuse [[Polyneuropathy|basilar polyneuropathy]] in 40% of the patients. with [[neurosarcoidosis]].
# [[Meningeal]] involvement: diffuse [[Meningitis|meningeal inflammation]] can cause diffuse [[Polyneuropathy|basilar polyneuropathy]] in 40% of the patients. with [[neurosarcoidosis]].
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* [[Lumbar puncture]] shows elevated [[CSF]] proteins together with mild-moderate [[pleocytosis]]. It is usually accompanied by [[oligoclonal bands]].<ref name="urlNeurosarcoidosis">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3975794/ |title=Neurosarcoidosis |format= |work= |accessdate=}}</ref>
* [[Lumbar puncture]] shows elevated [[CSF]] proteins together with mild-moderate [[pleocytosis]]. It is usually accompanied by [[oligoclonal bands]].<ref name="urlNeurosarcoidosis">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3975794/ |title=Neurosarcoidosis |format= |work= |accessdate=}}</ref>
|[[Magnetic resonance imaging|MRI]] with [[contrast]] shows enhancement of the inflamed areas (i.e. [[cranial nerves]], [[meninges]] or [[Hypothalamic pituitary adrenal axis|HPO axis]])
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* [[Magnetic resonance imaging|MRI]] with [[contrast]] shows enhancement of the inflamed areas (i.e. [[cranial nerves]], [[meninges]] or [[Hypothalamic pituitary adrenal axis|HPO axis]])
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{| class="wikitable"
{| class="wikitable"
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!Prominent clinical feature
!Prominent clinical feature
!Radiological findings
!Radiological findings
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|Ocular cysticercosis
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|[[Coats disease]]
|[[Coats disease]]
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|Hyperthyroid Ophthalmopathy
|Hyperthyroid Ophthalmopathy
|The hallmark is [[Exophthalmos|Eye protrusion]], [[photophobia]], [[lacrimation]] and later in the disease, diminished eye motility.<ref name="urlThyroid Ophthalmopathy - EyeWiki">{{cite web |url=http://eyewiki.aao.org/Thyroid_Ophthalmopathy |title=Thyroid Ophthalmopathy - EyeWiki |format= |work= |accessdate=}}</ref>
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* The hallmark is [[Exophthalmos|Eye protrusion]], [[photophobia]], [[lacrimation]] and later in the disease, diminished eye motility.<ref name="urlThyroid Ophthalmopathy - EyeWiki">{{cite web |url=http://eyewiki.aao.org/Thyroid_Ophthalmopathy |title=Thyroid Ophthalmopathy - EyeWiki |format= |work= |accessdate=}}</ref>
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* [[Ultrasonography]]: inflamed thickened [[extraocular muscles]].
* [[Ultrasonography]]: inflamed thickened [[extraocular muscles]].
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![[Image:Retinoblastoma-3.jpg|center|300px|thumb|MRI of the orbit showing retinoblastoma - Case courtesy of https://radiopaedia.org/. From the case https://radiopaedia.org/cases/11877]]
![[Image:Retinoblastoma-3.jpg|center|300px|thumb|MRI of the orbit showing retinoblastoma - Case courtesy of https://radiopaedia.org/. From the case https://radiopaedia.org/cases/11877]]


![[Image:Thyroid-orbitopathy-severe-2.jpg|center|300px|thumb|CT head showing hyperthyroid induced orbitopathy - Case courtesy of A.Prof Frank Gaillard, https://radiopaedia.org/. From the case https://radiopaedia.org/cases/4854]]
![[Image:Thyroid-orbitopathy-severe-2.jpg|center|300px|thumb|CT head showing hyperthyroid-induced orbitopathy - Case courtesy of A.Prof Frank Gaillard, https://radiopaedia.org/. From the case https://radiopaedia.org/cases/4854]]


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{{Reflist|2}}


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Latest revision as of 21:11, 29 July 2020

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

Overview

Cysticercosis must be differentiated from other diseases that cause brain cystic lesions (as brain abscess and brain tumors) or ocular lesions (as retinal detachment and coats disease).

Differentiating cysticercosis from other diseases

Differentiating neurocysticercosis from other brain cyst lesions
Disease Prominent clinical features Lab findings Radiological findings
Neurocysticercosis
Brain abscess
  • Lumbar puncture is contraindicated but when done, it was variable between patients.
  • Culture from the CT-guided aspirated lesion helps in identifying the causative agent.
Brain tumors
  • CT may be used in localizing the tumor and getting a rough estimate on the dimensions.
  • MRI: Gadolinium-enhanced MRI is the preferred imaging modality for assessing the extension of the tumor and its exact location.[3]
Brain tuberculoma
  • Presentations are usually due to the pressure effect, not the T.B. bacilli.
  • Presenting symptoms and signs in order of occurrence:[4]
  1. Episodes of focal seizures
  2. Signs of increased intracranial pressure
  3. Focal neurologic deficits.
  • CT: Contrast-enhanced CT scan shows a ring enhancing lesion surrounded by an area of hypodensity (cerebritis) and the resulting mass effect.
  • MRI: Better than CT scan in assessing the site and size of the tuberculoma. Gadolinium-enhanced MRI shows a ring enhancing lesion between 1-5 cm in size (In NCC, the wall is thicker, calcifications are eccentric and the diameter is less than 2 cm)
Neurosarcoidosis
  • 70% of the patients present with the neurological symptoms rather than the presentation of systemic disease. Common presentations are:[5]
  1. Cranial nerve neuropathies: Facial palsy is the most common presentation.
  2. Meningeal involvement: diffuse meningeal inflammation can cause diffuse basilar polyneuropathy in 40% of the patients. with neurosarcoidosis.
  3. Inflammatory spinal cord disease: Inflammatory span usually more than 3 spinal cord segments which helps to differentiate it from Multiple Sclerosis.
  4. Peripheral neuropathy: Asymmetric polyneuropathy or mononeuritis multiplex. It may also manifest as Guillain-Barré syndrome (GBS) like presentation.
  5. HPO axis involvement: may present as diabetes insipidus. More than 50% of the cases have no radiological signs.
MRI brain showing brain abscess - Case courtesy of A.Prof Frank Gaillard, https://radiopaedia.org/ From the case https://radiopaedia.org/cases/4933"
MRI brain showing Glioblastoma multiforme - Case courtesy of A.Prof Frank Gaillard, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/28272">rID: 28272</a>
MRI brain showing tuberculoma - Case courtesy of Dr G Balachandran, https://radiopaedia.org/ From the case https://radiopaedia.org/cases/5489"
MRI brain showing Neurosarcoidosis - Case courtesy of A.Prof Frank Gaillard, https://radiopaedia.org/ From the case https://radiopaedia.org/cases/4364S
Differentiating ocular cysticercosis from other ocular lesions
Disease Prominent clinical feature Radiological findings
Coats disease
Retinal detachment
Hyperthyroid Ophthalmopathy
Retinoblastoma
MRI of the orbit showing Coats disease - Case courtesy of Dr Michael Sargent, https://radiopaedia.org/. From the case https://radiopaedia.org/cases/6089
MRI of the orbit showing retinal detachment - Case courtesy of A.Prof Frank Gaillard, https://radiopaedia.org/. From the case https://radiopaedia.org/cases/3134
MRI of the orbit showing retinoblastoma - Case courtesy of https://radiopaedia.org/. From the case https://radiopaedia.org/cases/11877
CT head showing hyperthyroid-induced orbitopathy - Case courtesy of A.Prof Frank Gaillard, https://radiopaedia.org/. From the case https://radiopaedia.org/cases/4854

References

  1. Brouwer MC, Tunkel AR, McKhann GM, van de Beek D (2014). "Brain abscess". N. Engl. J. Med. 371 (5): 447–56. doi:10.1056/NEJMra1301635. PMID 25075836.
  2. "Brain Abscess — NEJM".
  3. 3.0 3.1 "Primary Brain Tumors in Adults - American Family Physician".
  4. "The Journal of Association of Chest Physicians - Tuberculoma of the brain - A diagnostic dilemma: Magnetic resonance spectroscopy a new ray of hope : Download PDF".
  5. 5.0 5.1 "Neurosarcoidosis".
  6. 6.0 6.1 "How to Diagnose and Manage Coats' Disease".
  7. 7.0 7.1 "Management of retinal detachment: a guide for non-ophthalmologists".
  8. 8.0 8.1 "Thyroid Ophthalmopathy - EyeWiki".
  9. 9.0 9.1 "c.ymcdn.com".