Clinicians should consider NCC in patients from Burma with epilepsy, chronic headache, or unexplained neurologic symptoms. Clinicians should also be aware of stigma and cultural interpretations related to epilepsy which may preclude patient disclosure of seizures. The primary tools for diagnosis of NCC include neuroimaging and serology assays. However, additional clinical and

epidemiologic criteria are usually required to establish the diagnosis per consensus guidelines.6 CX-4945 price Occasionally, a definitive diagnosis is possible with neuroimaging by demonstration of a visible scolex within a cyst, or with histopathologic confirmation of an excised or biopsied cyst. Head CT readily identifies most forms of NCC and can facilitate detection of small calcifications. The fine resolution possible with MRI aids in detection of smaller cysts, as well as cysts near bony structures or within the ventricles. The EITB LLGP serologic assay is highly specific (∼100%) and sensitive (∼98%) for detection of NCC involving more than one cyst.7 However, false-negative results frequently occur in NCC involving only calcified cysts, or in cases involving a single parenchymal cyst. Recently developed assays detect T solium cyst antigens or DNA in serum, cerebrospinal fluid, or urine, but these are not yet routinely available and their contribution

to clinical diagnosis remains unclear. Further detail regarding diagnosis, treatment, and outcome of NCC is available in recent reviews.1,8,9 Consideration of the health of the patient’s family is important JQ1 cell line when NCC is diagnosed as there may be additional infections within the household. In addition to NCC acquired in the country of origin,

transmission can occur after resettlement as an adult intestinal tapeworm can live for several years. Exposure may also be maintained through travel and visiting friends and relatives. Stool PAK5 examination of the index NCC case and household members can identify taeniasis and treatment may prevent additional NCC cases.10–12 Stool screening is accomplished preferentially by ELISA for Taenia sp. coproantigens or otherwise by light microscopy for eggs and proglottids. A combination of symptom screening, serology, and neuroimaging may identify additional cases of NCC. Finally, in the case we present here as well as in the case described by Hewagama and colleagues, neurologic symptoms first appeared within days of treatment with albendazole or praziquantel for presumed intestinal helminth infection. Both medications penetrate the CNS well and are used in the treatment of NCC, typically in conjunction with corticosteroids to control resulting inflammation. The Food and Drug Administration recently updated labels for both drugs to warn clinicians of the possibility of precipitating inflammatory reactions in patients with occult asymptomatic NCC. Multiple suspected adverse reactions of this type have been reported.