Diagnosis of cysticercosis

Revised diagnostic criteria for neurocysticercosis
Categories of criteria	Criteria
Absolute	Histologic demonstration of the parasite from biopsy of a brain or spinal cord lesion
	Cystic lesions showing the scolex on CT or MRI
	Direct visualization of subretinal parasites by funduscopic examination
Major	Lesions highly suggestive of neurocysticercosis on neuroimaging studies*
	Positive serum EITB^¶ for the detection of anticysticercal antibodies
	Resolution of intracranial cystic lesions after therapy with albendazole or praziquantel
	Spontaneous resolution of small single enhancing lesions^Δ
Minor	Lesions compatible with neurocysticercosis on neuroimaging studies^◊
	Clinical manifestations suggestive of neurocysticercosis^§
	Positive CSF ELISA for detection of anticysticercal antibodies or cysticercal antigens
	Cysticercosis outside the CNS^¥
Epidemiologic	Evidence of a household contact with Taenia solium infection
	Individuals coming from or living in an area where cysticercosis is endemic
	History of frequent travel to disease-endemic areas
Revised degrees of certainty for the diagnosis of neurocysticercosis
Diagnostic certainty	Criteria
Definitive	Presence of one absolute criterion
Definitive	Presence of two major plus one minor and one epidemiologic criterion
Probable	Presence of one major plus two minor criteria
	Presence of one major plus one minor and one epidemiologic criterion
	Presence of three minor plus one epidemiologic criterion
The presence of two different lesions highly suggestive of neurocysticercosis on neuroimaging studies should be considered as two major diagnostic criteria. However, positive results in two separate types of antibody detection tests should be interpreted only on the basis of the test falling in the highest category of diagnostic criteria.

CT: computed tomography; MRI: magnetic resonance imaging; EITB: enzyme-linked immunoelectrotransfer blot assay; CSF: cerebrospinal fluid; ELISA: enzyme-linked immunosorbent assay; CNS: central nervous system.
* CT or MRI showing cystic lesions without scolex, enhancing lesions, or typical parenchymal brain calcifications.
¶ EITB using purified extracts of Taenia solium antigens, as developed by the Centers for Disease Control and Prevention (Atlanta, GA).
Δ Solitary ring-enhancing lesions measuring less than 20 mm in diameter in patients presenting with seizures, a normal neurologic examination, and no evidence of an active systemic disease.
◊ CT or MRI showing hydrocephalus or abnormal enhancement of the leptomeninges, and myelograms showing multiple filling defects in the column of contrast medium.
§ Seizures, focal neurologic signs, intracranial hypertension, and dementia.
¥ Histologically confirmed subcutaneous or muscular cysticercosis, plain radiograph films showing "cigar-shaped" soft-tissue calcifications, or direct visualization of cysticerci in the anterior chamber of the eye.

Reproduced with permission from: Del Brutto OH, Rajshekharm V, White AC, et al. Proposed diagnostic criteria for neurocysticerosis. Neurology 2001; 57:177. Copyright © 2001 Lippincott Williams & Wilkins.

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Diagnosis of cysticercosis