Neurocysticercosis: clinical manifestation, neuroimaging, serology and molecular confirmation of histopathologic specimens.

Diagnosis of neurocysticercosis (NCC) is usually based on neuroimaging and/or immunological analysis of cerebrospinal fluid (CSF) and/or serum samples for detection of specific antibodies against T. solium antigens. Additional confirmative diagnosis may be possible by morphological and molecular confirmation of resected histopathologic specimens. The majority of NCC cases do not always show typical neuroimaging figures with invaginated scolex. So, serology using highly specific antigens of T. solium, either semi-purified native or recombinant antigens, is essential for confirming NCC cases. There is some debate about the usefulness of CSF and serum for immunodiagnosis. When NCC cases with a solitary cyst or with calcified lesions are examined, serology is not always sensitive to differentiating such cases. Malignant brain tumor is most commonly suspected in Japan and is often treated surgically as an urgent task, if the clinicians have no experience of NCC cases. Only histopathological specimens are expected to show direct evidence of T. solium cysticercosis. Morphology is not always sufficient for identification of the Taenia species, even if the majority of cysticerci in the human brain are expected to be T. solium. Crucial confirmation is based on molecular identification. In this review, these four issues are briefly summarized.