Description

MRI of the brain and short tau inversion recovery (STIR) coronal imaging of the whole body were performed on a 49-year-old man, who presented with multiple episodes of generalised tonic clonic seizures, generalised muscular hypertrophy and muscle-ache of 3 months’ duration.

Brain MRI revealed multiple discrete nodular lesions showing variable signal intensity scattered diffusely in a miliary pattern throughout the brain parenchyma. The lesions appeared hyperintense on T2-weighted images (figure 1A) and hypointense on T1-weighted (figure 1B) images, with an eccentric hyperintense focus within most. A few lesions showed perilesional oedema and some showed calcification within, which was seen as blooming on flash images (figure 1C). Similar lesions were also seen involving the ventricular system and ocular and tongue muscles (arrows in figure 1B), and scalp muscles (arrow in figure 1A). Findings revealed disseminated cysticercosis in various stages of their life cycle. Whole body STIR coronal images (figure 2A–C) depicted cysticerci involving almost every muscle of the body. The muscles appeared bulky and the cysticerci were clearly seen as hyperintense nodules against the dark background of muscle.

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Figure 1

(A–C) T1 weighted sagittal (A), and T2-weighted axial (B) and FLAIR coronal (C) MRIs of the brain showing disseminated cysticerci with an eccentric hyperintense focus within most, and a few showing oedema (arrow in C). Similar lesions are seen involving ocular and tongue muscles (arrows in B), and scalp muscles (arrow in A).

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Figure 2

(A–C) Whole body short tau inversion recovery (STIR) coronal images depict bulky muscles with cysticerci seen as hyperintense nodules within.

The patient was started on anticystoidal treatment with oral steroids and antiepileptics, which helped in stabilisation of the clinical condition.

Cysticercosis results in humans after ingestion of Taenia solium eggs, usually orally from egg-contaminated food or water, or through inhalation of egg-bearing matter. Disseminated cysticercosis, involving the brain, tongue, orbit and almost every muscle of the body, as in our case, is a rare and life-threatening disease, with very few cases reported in the literature.1–3 Diagnosis of intramuscular cysticerci involvement is difficult clinically as these are usually deep seated and difficult to palpate. Whole body MRI is a very useful and safe modality for diagnosing this condition, and leads to timely management and the circumvention of invasive tests. Pretreatment with corticosteroids before the use of cysticidal drugs decreases the incidence of associated anaphylactic complications.