Solitary cysticercus granuloma of the brainstem. Report of four cases.

Isolated brainstem involvement in patients who have neurocysticercosis is rare. The authors describe the clinical and radiological features of four patients with a solitary cysticercus granuloma of the brainstem and discuss their case management. In three of the patients the onset of symptoms was fairly rapid, occurring over a few days. The granuloma appeared as an enhancing lesion measuring 20 mm or less, with a ring- or disklike appearance on computerized tomography and magnetic resonance imaging. A stereotactic biopsy provided the definitive diagnosis in one patient. In two patients the granuloma resolved spontaneously with complete regression of symptoms and signs and in one patient the granuloma resolved following albendazole therapy. In all patients, outcome was excellent or good (follow-up evaluation 6 months-3 years) with only one patient having persistent paresthesias on one side of his body. Because spontaneous resolution is the rule, a conservative approach to case management, including observation, is recommended. The importance of recognizing this entity and avoiding unnecessary surgical intervention or empirical antituberculous chemotherapy is emphasized.