Criteria

Revised diagnostic criteria for neurocysticercosis[42]

Absolute criteria:

  • Histological demonstration of the parasite from biopsy of a brain or spinal cord lesion

  • Visualisation of sub-retinal cysticercus

  • Conclusive demonstration of a scolex within a cystic lesion on neuroimaging studies.

Neuroimaging criteria:

  • Major neuroimaging criteria:

    • Cystic lesions without a discernible scolex

    • Enhancing lesions

    • Multilobulated cystic lesions in the subarachnoid space

    • Typical parenchymal brain calcifications

  • Confirmative neuroimaging criteria:

    • Resolution of cystic lesions after cysticidal drug therapy

    • Spontaneous resolution of single small enhancing lesions (use of corticosteroids makes this criterion invalid)

    • Migration of ventricular cysts documented on sequential neuroimaging studies

  • Minor neuroimaging criteria:

    • Obstructive hydrocephalus (symmetrical or asymmetrical) or abnormal enhancement of basal leptomeninges.

Clinical/exposure criteria:

  • Major clinical/exposure:

    • Detection of specific anticysticercal antibodies or cysticercal antigens by well-standardised immunodiagnostic tests

    • Cysticercosis outside the central nervous system

    • Evidence of a household contact with Taenia solium infection

  • Minor clinical/exposure:

    • Clinical manifestations suggestive of neurocysticercosis

    • Individuals coming from or living in an area where cysticercosis is endemic.

Definitive diagnosis:

  • One absolute criterion

  • Two major neuroimaging criteria plus any clinical/exposure criteria

  • One major and one confirmative neuroimaging criterion plus any clinical/exposure criteria

  • One major neuroimaging criterion plus two clinical/exposure criteria (including at least one major clinical/exposure criterion), together with the exclusion of other pathologies producing similar neuroimaging findings.

Probable diagnosis:

  • One major neuroimaging criterion plus any two clinical/exposure criteria

  • One minor neuroimaging criterion plus at least one major clinical/exposure criterion.

Separate diagnostic criteria for parenchymal and extraparenchymal neurocysticercosis have been suggested.[43]

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