Migrating intraventricular cysticercosis: magnetic resonance imaging findings

Dr. Emerson L. Gasparetto – Rua Lopes Trovao 88 / 1702B 24110-071 Niteroi RJ Brasil. Neurocysticercosis (NCC) is the most common parasitic infestation affecting the central nervous system (CNS). It is frequent cause of seizures and hydrocephalus in adults from endemic regions, including Brazil. Brain parenchymal involvement occurs in 60 to 92% of patients with NCC, but intraventricular (IV) lesions are seen in only 7 to 20% of cases. Although NCC is usually self-limited by the life cycle of the parasite, intraventricular involvement is often more difficult to manage due to obstruction of cerebrospinal fluid (CSF) pathways and ependymal inflammation. Intraventricular neurocysticercosis (IVNCC) can produce mechanical obstruction of CSF flow anywhere in the ventricular system, resulting in hydrocephalus or focal neurological deficits. The symptoms can also result from ependymal inflammation associated with cyst degeneration, or from diffuse meningitis causing communicating hydrocephalus. The intraventricular cysts may circulate freely throughout the CSF pathways or become attached to the ependyma anywhere in the ventricles, but their predilection is for the occipital horn of the lateral and fourth ventricles. Although the obstruction of the CSF flow is a common cause of symptoms in patients with IVNCC, reports demonstrating the migrating cysts causing hydrocephalus are extremely rare. We report a case of intraventricular neurocysticercosis presenting with hydrocephalus due to third ventricle obstruction secondary to migrating cysticercus.