1/ Back again #IDTwitter, #MedEd, & #TropMed folks... This is parenchymal neurocysticercosis! The cyst on the right is degenerating and colloidal, and the two cysts on the left are viable.
Note the fabulous scoleces in each cyst 👇
Note the fabulous scoleces in each cyst 👇
https://twitter.com/Coyle_CM/status/1386321597997281285
2/ The images shown are MRI FLAIR sequences👆. You really need more than one sequence when staging parenchymal NCC.
3/ A CT helps identify calcifications.
On an MRI:
A T1 post-contrast image tells you how much enhancement there is around the cyst.
A T2-weighted image tells you if there is fluid in the cyst.
The FLAIR image is best to visualize peri-cystic edema and also the scolex.
On an MRI:
A T1 post-contrast image tells you how much enhancement there is around the cyst.
A T2-weighted image tells you if there is fluid in the cyst.
The FLAIR image is best to visualize peri-cystic edema and also the scolex.
4/ Let's look at his CT scan and all of his MRI sequences side by side.... 
5/ This patient has more than 2 viable cysts; therefore,
dual antiparasitic therapy (albendazole + praziquantel) in conjunction with steroids are recommended.
dual antiparasitic therapy (albendazole + praziquantel) in conjunction with steroids are recommended.
6/ This is a great article which shows the efficacy of dual therapy in those cases of parenchymal disease with more than 2 cysts:
pubmed.ncbi.nlm.nih.gov/24999157/
pubmed.ncbi.nlm.nih.gov/24999157/
7/ ...Don't forget to check the guidelines when managing a patient with NCC!
idsociety.org/practice-guide…
idsociety.org/practice-guide…
• • •
Missing some Tweet in this thread? You can try to
force a refresh
