1315. Clinical, Radiological and Serologic Characteristics of Patients with Subarachnoid Neurocysticercosis: A Large Series from a Single Center in New York City

• Published in: Open forum infectious diseases 2023-11, Vol.10 (Supplement_2)
• Main Authors: Berto, Cesar G, Sacchi, Robert, Levitt, Alexander, O’Connell, Elise, Coyle, Christina
• Format: Article
• Language: English
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofad500.1154

Abstract Background Subarachnoid neurocysticercosis (SANCC) is the most severe and difficult-to-treat form of neurocysticercosis (NCC). Methods We describe the clinical, radiologic, and serologic characteristics of the largest series of patients with SANCC in a non-endemic area by reviewing the medical records of patients seen at Jacobi Medical Center in New York. Results From 313 cases of NCC, 103 patients (32.9%) had subarachnoid involvement. Most individuals were male (65.1%) and born in Mexico (37.9%); the mean age was 41.4 years. Thirty-seven patients had only subarachnoid involvement, 50 patients had both parenchymal and SANCC, 5 patients had both intraventricular and SANCC, and 11 patients had all three spaces involved. Seventy-one patients (68.9%) presented with headaches. Of these, 35 patients had intracranial hypertension, and 27 required shunt placement. Thirty patients (29.1%) presented with seizures, most of whom had concomitant parenchymal disease. Fourteen patients (13.6%) presented as an ischemic event, 12 patients (11.7%) had symptoms due to spinal disease, and 8 patients (7.8%) had aseptic meningitis. Screening for spinal disease was performed on 61 patients. Of these, 14 patients (23.0%) had asymptomatic spinal involvement. Delay in diagnosis was found in 48 patients (49.0%) with a median of 12 months; chronic headache was the most common missed symptom (48.2%). Calcified SANCC was found in 37 patients (35.9%). Of these, 18 patients (18.4%) did not receive previous antiparasitic. Based on both CT scans and MRIs, 14 of these patients were categorized as completely calcified, and 23 patients were partially calcified with a cystic component seen on MR T2 images. The cysticercosis antigen in serum and CSF were negative in all cases of completely calcified and only in one partially calcified SANCC. Conclusion This is the largest series of SANCC reported from a single center in the US and highlights the clinical spectrum. Our data also shows an important under-recognition of this severe form by the clinician and reports that calcified SANCC is common and can occur before and after treatment. Disclosures All Authors: No reported disclosures