Subarachnoid hemorrhage in neurocysticercosis: a direct or serendipitous association?

INTRODUCTION: The cerebrovascular complications in neurocysticercosis (NC) are uncommon. However, their pathophysiology remains unknown, but may be likely related to chronic inflammatory processes in the subarachnoid space (basal meningitis). Alterations of inflammatory cytokines in cerebrospinal fluid and sera correlate with vasospasm in SAH; these inflammatory mediators in NC may induce aneurysm formation.

CASE REPORTS: A 7-year retrospective study in a neurological referral center (Instituto Nacional de Neurología y Neurocirugía), showed 3 cases of subarachnoid hemorrhage (SAH) among the 267 NC patients admitted during the study period. The clinical status, cerebrospinal fluid parameters, and clinical outcome were retrieved to compare them with previous NC-related SAH reported patients. Six of 15 patients showed aneurysm. These aneurysms were found within foci of inflammation and fibrosis surrounding the parasites.

CONCLUSIONS: We found that, in contrast with the ominous prognosis of SAH for ruptured congenital aneurysm, cases associated with NC may have a more benign course. However with limited clinical information provided by previous reports, we only propose a possible direct relationship between chronic inflammation and NC as an inference because of the limited evidence available.