Head, Department of Neurology, PGIMER, Dr. Ram Manohar Lohia Hospital, ... New Delhi - 110 001, ** All India Institute of Medical Sciences, Ansari Nagar, ...
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JIACM 2010; 11(4): 300-301
An Unusual Cause of Dementia KS Anand*, Vikas Dhikav**
Abstract A 54-year-old man presented with progressive dementia in whom diffuse cerebral cysticercosis with ventricular cyst and hydrocephalous was subsequently demonstrated. He responded favourably to cysticidal therapy. This report demonstrates the importance of excluding neurocysticercosis (NCC) as treatable and reversible cause of dementia. NCC should be considered in the differential diagnosis of dementia, especially in endemic areas.
Case report A 54-year-old police constable visited to the Department of Neurology, Dr. Ram Manohar Lohia Hospital, New Delhi, in March, 2005 with a seven-months history of irrelevant talking, poor self-care, insomnia, fidgetiness, dressing and undressing, and assaultive behavior. Additionally, he had loss of memory, ataxia, incontinence of urine, disinhibited behaviour, and he used to pass sexual remarks at females. His personal history did not suggest of any substance abuse or morbid personality. There was no history of head trauma or any stressful event prior to onset of the illness. General physical and neurological examinations were unremarkable. On mental status examination, he was poorly kempt with emotional variability and disoriented behaviour. Rapport could not be established with him, and his motor behaviour was inappropriate with features of agitation and uncooperativeness. His speech was incomprehensible and his thought process, perception, cognition, judgement, and insight were impaired. His mini mental status examination (MMSE) score for assessment of cognitive functions was < 10. Routine haemogram, blood sugar, liver function tests, and kidney function tests were within laboratory limits. Chest radiographs and ultrasonography of abdomen showed no abnormality. Ultrasonography of right eye showed vitreous degeneration, while left eye had retinal detachment with cysticercal cyst. MRI of head revealed multiple neurocysticerci with features of obstructive hydrocephalous in the region of the posterior ventricular
wall/posterior aspect of midbrain. The ELISA for IgG antibody against Taenia solium glycoprotein in serum was positive. The patient was diagnosed as a case of cysticercal dementia and was treated with 15 mg/kg albendazole, and dexamethasone daily for 28 days. On reviewing the case after 4 months, there was significant improvement in his clinical presentation. He was also able to control his gait, bladder, and bowel function. His orientation, self-care and behaviour had improved. His speech was comprehensible and his MMSE score for cognitive function was 10.
Discussion Neurocysticercosis is the most frequent parasitic disease of the nervous system, and is a growing problem in industrialised countries because of immigration of tapeworm carriers from areas of endemic disease. NCC has varied presentations. We previously reported a case of NCC with psychosis 1 and cysticercal dementia 2. NCC is a pleomorphic disease and the pleomorphism is due to variations in the locations of the lesions, the number of parasites, and the host’s immune response.The main clinical manifestations of neurocysticercosis are seizures, headache, and focal neurological deficits, and it can have sequealae such as epilepsy, hydrocephalus, and dementia3. Infectious diseases are reversible causes of dementia4. NCC-induced dementia is reversible in most cases5. NCC should be considered in the differential diagnosis of dementia, especially in endemic areas.
* Head, Department of Neurology, PGIMER, Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi - 110 001, ** All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029.
2002; 2 (12): 751-62.
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Ramirez-Bermudez J, Higuera J, Sosa AL et al. Is dementia reversible in patients with neurocysticercosis? Neurol Neurosurg Psychiatry 2005; 76 (8): 1164-6.
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