Neurocysticercosis-Associated Meningitis: A Systematic Review

ABSTRACT: Neurocysticercosis is a frequent parasitic infection of the central nervous system. While parenchymal forms are well recognized, meningitis due to cysticercus remains underdiagnosed. This systematic review assessed clinical features, diagnostics, treatment, and outcomes of neurocysticercosis-associated meningitis. Following PRISMA guidelines and PROSPERO registration, case reports, series, and cohorts describing meningitis attributed to neurocysticercosis were analyzed. Extracted data included demographics, presentation, imaging, cerebrospinal fluid (CSF) findings, diagnostics, therapy, and outcomes. A total of 48 published cases of neurocysticercosis-associated meningitis were analyzed. Headache was the most common presenting symptom (45 cases, 94%), followed by fever and vomiting (20 cases each, 42%), visual impairment or gait disturbance (16 cases, 33%), altered sensorium (15 cases, 31%), and seizures (13 cases, 27%). Chronic meningitis (13 cases, 27%) and meningoencephalitis (10 cases, 21%) were the most frequent subtypes. Neuroimaging most often showed subarachnoid or racemose cysts (14 cases, 29%) and hydrocephalus (13 cases, 27%). Cerebrospinal fluid analysis revealed elevated opening pressure (27 cases, 56%), lymphocytic pleocytosis (25 cases, 52%), eosinophilic pleocytosis (12 cases, 25%), elevated protein (42 cases, 88%), and low glucose (35 cases, 73%). Surgical intervention was required in 26 cases (54%). Albendazole, corticosteroids, and praziquantel were used in 42 (88%), 21 (44%), and 18 (38%) cases, respectively. Complete recovery occurred in 17 cases (35%), and mortality in 3 cases (6%). Neurocysticercosis-associated meningitis is a severe, often subarachnoid disease marked by diagnostic delay and frequent surgical need, but outcomes are favorable when timely, individualized medical/ surgical management is instituted.