title: Cysticercal chronic basal arachnoiditis with infarcts, mimicking tuberculous pathology in endemic areas.
abstract: Neurocysticercosis (NCC) is the most common of the parasitic diseases affecting the CNS, with protean clinical manifestations. Stroke as a complication of NCC occurs in a very small percentage of cases, mostly involving small perforating vessels while major intracranial vessel involvement is extremely rare. The present report involves two autopsied cases of chronic cysticercal basal arachnoiditis causing large arterial territory infarcts and, in the second case, a hypothalamic mass. They were diagnosed and managed, clinically and by neuroimaging, as stroke and neurotuberculosis, respectively. The diagnosis was established only at autopsy, which revealed NCC causing basal arachnoiditis, major vessel vasculitis and infarcts. Histologically, case 1 showed degenerating racemose cysticercal cyst within the thick basal exudate. In the second case, remnants of the degenerated cysticercal cyst in the form of hooklets and calcareous corpuscles were identified within the giant cell inciting a granulomatous response to form a hypothalamic mass lesion mimicking tuberculoma. The present case report highlights the importance of considering the non-tuberculous etiologies of chronic basal arachnoiditis like NCC before initiating therapy especially in countries endemic to both NCC and tuberculosis, like India.
authors.affiliation: Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India.
authors.forename: Gopaliah Shivane
authors.initials: GS
authors.lastname: Aditya
authors.forename: Anita
authors.initials: A
authors.lastname: Mahadevan
authors.forename: Vani
authors.initials: V
authors.lastname: Santosh
authors.forename: Yasha Thagadur
authors.initials: YT
authors.lastname: Chickabasaviah
authors.forename: Chandramouli Bangalore
authors.initials: CB
authors.lastname: Ashwathnarayanarao
authors.forename: Shankar Susarla
authors.initials: SS
authors.lastname: Krishna
mesh_terms: D000328:Adult; D001100:Arachnoiditis / Q000175:diagnosis*; D002544:Cerebral Infarction / Q000175:diagnosis*; D002908:Chronic Disease; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D020019:Neurocysticercosis / Q000175:diagnosis*; D014390:Tuberculosis, Meningeal / Q000175:diagnosis*