Imaging of neurocysticercosis and the influence of the human immunodeficiency virus

Abstract

To review the literature on the imaging appearances of neurocysticercosis (NCC) and human immunodeficiency virus (HIV) co-infection and compare it with the local cases. Data from both published and local cases were analysed. HIV-infected cases were divided into "low" (<200 cells/mm3) and "high" (≥200 cells/mm3) CD4 groups. These groups were compared and the effect of treatment was evaluated. Thirty-three cases were evaluated: 20 of the local cases and 13 published cases. The published cases had parenchymal brain cysts, whereas the local cases had both parenchymal and subarachnoid cysts (p=0.0050). The published cases also had intra-axial cysts, whereas the local cases had both intra- and extra-axial cysts (p=0.012). The published cases had predominantly cystic lesions, whereas the local cases had both cystic and granulomatous lesions (p=0.019). There were no differences between cases with a CD4 count of <200 cells/mm3 and cases with a CD4 count of ≥200 cells/mm3, but interestingly, 3% of the cases with a CD4 count of <500 cells/mm3, compared with 50% of the cases with a CD4 count of ≥500 cells/mm3, had racemose cysts. NCC is very prevalent in South Africa and may complicate the diagnosis and treatment of patients with concomitant HIV infection. Patients with a "low" CD4 count may present with atypical lesions, delaying the diagnosis of NCC. Early initiation of highly active anti-retroviral therapy (HAART) may result in patients presenting with more classical symptoms and imaging appearances, thus improving outcomes.