Isolated brainstem cysticercosis: A review

Objective: Review of patients with isolated brainstem cysticercus to outline the features of this form of neurocysticercosis. Methods: MEDLINE and manual search of patients with isolated brainstem cysticercus. Abstracted data included: demographic profile, clinical manifestations, neuroimaging findings, evolutive stage of parasites neurocysticercosis, therapy, and follow-up. Results: Twenty-nine patients were reviewed. Of these, 22 (76%) came from India. Mean age was 31 years, and 72% were men. Parasites were located in midbrain (16 patients), pons (12 patients), and medulla (one patient). All but three lesions were less than 10 mm in diameter and most were at or near the midline. Most common clinical forms of presentation were isolated paresis of the third cranial nerve, internuclear ophthalmoplegia, and crossed brainstem syndromes. Neuroimaging studies showed colloidal cysticercus in 24 patients, vesicular cysts in four, and a calcification in one. Fourteen patients received cysticidal drugs, eight were treated with steroids alone, and three received no therapy at all. The remaining four patients underwent surgical resection of the lesion. Twenty-seven patients recovered completely and the remaining two were left with mild sequelae. Control neuroimaging studies showed complete or partial resolution of the lesion in the 18 patients in whom they were performed. Conclusions: Isolated brainstem cysticercosis is rare. Clinical and neuroimaging findings on admission allowed a correct differentiation of this condition from other space-occupying lesions of the brainstem (tuberculomas, abscesses, gliomas) in most patients. The prognosis is benign provided the patients receive prompt therapy.