Cysticercal chronic basal arachnoiditis with infarcts, mimicking tuberculous pathology in endemic areas

Authors: Gopaliah Shivane Aditya¹; Anita Mahadevan¹; Vani Santosh¹; Yasha Thagadur Chickabasaviah¹; Chandramouli Bangalore Ashwathnarayanarao²; Shankar Susarla Krishna

Source: Neuropathology, Volume 24, Number 4, December 2004 , pp. 320-325(6)

Publisher: Wiley-Blackwell

Abstract:

Neurocysticercosis (NCC) is the most common of the parasitic diseases affecting the CNS, with protean clinical manifestations. Stroke as a complication of NCC occurs in a very small percentage of cases, mostly involving small perforating vessels while major intracranial vessel involvement is extremely rare. The present report involves two autopsied cases of chronic cysticercal basal arachnoiditis causing large arterial territory infarcts and, in the second case, a hypothalamic mass. They were diagnosed and managed, clinically and by neuroimaging, as stroke and neurotuberculosis, respectively. The diagnosis was established only at autopsy, which revealed NCC causing basal arachnoiditis, major vessel vasculitis and infarcts. Histologically, case 1 showed degenerating racemose cysticercal cyst within the thick basal exudate. In the second case, remnants of the degenerated cysticercal cyst in the form of hooklets and calcareous corpuscles were identified within the giant cell inciting a granulomatous response to form a hypothalamic mass lesion mimicking tuberculoma. The present case report highlights the importance of considering the non-tuberculous etiologies of chronic basal arachnoiditis like NCC before initiating therapy especially in countries endemic to both NCC and tuberculosis, like India.

Keywords: granulomatous angiitis; major vessel arteritis; neurocysticercosis; neurotuberculosis; parasitic infestation

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1440-1789.2004.00564.x

Affiliations: 1: Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India and 2: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India

Publication date: 2004-12-01

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