Diagnostic criteria for neurocysticercosis (*)
| Categories of criteria |
Criteria |
| Absolute |
1. Histologic demonstration of the parasite from biopsy of a brain or spinal cord lesion 2. Cystic lesions showing the scolex on CT or MRI 3. Direct visualization of subretinal parasites by funduscopic examination |
| Major |
1. Lesions highly suggestive of neurocysticercosis on neuroimaging studies (1) 2. Positive serum EITB (2) for the detection of anticysticercal antibodies 3. Resolution of intracranial cystic lesions after therapy with albendazole or praziquantel 4. Spontaneous resolution of small single enhancing lesions (3) |
| Minor |
1. Lesions compatible with neurocysticercosis on neuroimaging studies (4) 2. Clinical manifestations suggestive of neurocysticercosis (5) 3. Positive CSF ELISA for detection of anticysticercal antibodies or cysticercal antigens 4. Cysticercosis outside the CNS (6) |
| Epidemiologic |
1. Evidence of a household contact with Taenia solium infection 2. Individuals coming from or living in an area where cysticercosis is endemic 3. History of frequent travel to diseaseendemic areas |
(1) CT or MRI showing cystic lesions without scolex, enhancing lesions, or typical parenchymal brain calcifications.
(2) Enzyme-linked immunoelectrotransfer blot assay using purified extracts of Taenia solium antigens, as developed by the Centers for Disease Control and Prevention (Atlanta, GA).
(3) Solitary ring-enhancing lesions measuring less than 20 mm in diameter in patients presenting with seizures, a normal neurologic examination, and no evidence of an active systemic disease.
(4) CT or MRI showing hydrocephalus or abnormal enhancement of the leptomeninges, and myelograms showing multiple filling defects in the column of contrast medium.
(5) Seizures, focal neurologic signs, intracranial hypertension, and dementia.
(6) Histologically confirmed subcutaneous or muscular cysticercosis, plain X-ray films showing "cigar-shaped" soft-tissue calcifications, or direct visualization of cysticerci in the anterior chamber of the eye. ELISA = enzyme-linked immunosorbent assay.
Degrees of certainty for the diagnosis of neurocysticercosis (*)
| Diagnostic certainty | Criteria |
| Definitive |
1. Presence of one absolute criterion 2. Presence of two major plus one minor and one epidemiologic criterion |
| Probable |
1. Presence of one major plus two minor criteria 2. Presence of one major plus one minor and one epidemiologic criterion Presence of three minor plus one epidemiologic criterion |
The presence of two different lesions highly suggestive of neurocysticercosis on neuroimaging studies should be considered as two major diagnostic criteria. However, positive results in two separate types of antibody detection tests should be interpreted only on the basis of the test faIling in the highest category of diagnostic criteria.
(*) From: O.H. Del Brutto, MD; V. Rajshekhar, MCh; A.C. White Jr., MD; V.C.W. Tsang, PhD; T.E. Nash, MD; O.M. Takayanagui, MD; P.M. Schantz, DVM, PhD; C.A.W. Evans, MD; A. Flisser, DSc; D. Correa, DSc; D. Botero, MD; J.C. Allan, PhD; E. Sarti, MD, DSc; A.E. Gonzalez, DVM, PhD; R.H. Gilman, MD; and H.H. García, MD Proposed diagnostic cri teria for neurocysticercosis Neurology 57, pp 177-183, 2001