Cysticercosis differential diagnosis

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Overview

Cysticercosis must be differentiated from other diseases that cause brain lesions and ocular lesions.

Disease	Prominent clinical feature	Lab findings	Radiological findings
Neurocysticercosis	Parenchymal lesions: Presentation depends on the site and number of lesions. Seizures are the most common presentation. It is mostly focal but can have a secondary generalization.	Lab findings are nonspecific.
Brain abscess	Headaches are the most common symptom. Usually, headaches occur on the same side of the abscess and tend to be severe (not responding to analgesics). Fever is not a reliable sign .(2)	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.	Contrast enhances CT provides rapid assessment of the size and number of the abscesses. MRI: Diffusion-weighted imaging (DWI) MRI can differentiate brain abscesses from cystic brain lesions with sensitivity and specificity of 96% (3)
Brain tumors	Most common presenting symptom is dull aching headache. Usually, it's associated with other symptoms of increased intracranial pressure (ICP) as seizures, visual disturbances, nausea and vomiting. (4)		CT may be used in 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. (4)
Brain tuberculoma	Brain tuberclomas has insidious onset of symptoms as compared to tuberclous meningitis. Presentations are ususally due to the pressure effect not the T.B. bacilli. Presenting symptoms and signs in order of occurence: (5) Episodes of focal seizures Signs of icreased intracranial pressure Focal neurologic deficits.		CT : Contrast enhanced CT scan shows a ring enhancing lesion surrounded by an area of hypodensity (cerebritis) and and the resulting mass effect. MRI: Better than Ct scan in assessing the site and size of the tubercloma. 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
Encephalitis

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