1156

Neurocysticercosis and Pure
Motor Hemiparesis
Fernando Barinagarrementeria, MD, and Oscar H. Del Brutto, MD

A 49-year-old man with meningeal cysticercosis presented with a pure motor hemiparesis.
Computed tomography and magnetic resonance imaging showed a capsular infarction and a
suprasellar cyst with surrounding arachnoiditis. Cerebrospinal fluid analysis confirmed the
diagnosis as it showed positive immunologic reactions to cysticerci. This is the first reported case
of pure motor hemiparesis due to a parasitic disease of the central nervous system. (Stroke
1988;19:1156-1158)

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ure motor hemiparesis (PMH) is one of the
most common lacunar syndromes,1 accounting for up to 60% of lacunar strokes.2 It is
usually caused by a small infarction in the internal
capsule,3 basis pontis,34 cerebral peduncle,5 or medullary pyramid.6 In addition, several causes of PMH
other than lacunar infarction have been reported.
Among these are intracerebral hemorrhage,7 brainstem glioma,8 metastatic tumor,9 subdural hematoma,9
multiple sclerosis,9 nocardial abscess,10 and meningovascular syphilis.11 Parasitic diseases of the central
nervous system could also cause PMH, but they have
not been described in this setting. We report a patient
with cysticercosis and PMH.

P

suprasellar cyst and revealed heterogeneous changes
in the signal intensity of the suprasellar cistern,
consistent with arachnoiditis (Figure 2). Extracranial Doppler ultrasonography did not detect
lesions in the neck vessels. Lumbar puncture yielded
a clear cerebrospinal fluid (CSF) under normal
pressure with 187 mononuclear cells/mm3, 9 mg
proteins/dl, and 50 mg glucose/dl; immunologic reactions to cysticerci (enzyme-linked immunosorbent
assay and complement fixation test) were positive.
The patient spontaneously improved, and a repeat
neurologic examination 2 months after the event
revealed minimal right leg paresis.

Case Report
A 49-year-old right-handed man with a history of
taeniasis was evaluated 1 week after the acute onset
of right motor deficit and an inability to speak. On
admission, his blood pressure was 110/70 mm Hg
and his general physical examination was normal.
Neurologic examination showed an alert patient
with motor dysphasia. Cranial nerve functions including pupillary responses, ocular movements, and facial
sensation were normal. There was a right hemiparesis
with crural dominance. Muscle stretch reflexes were
+ + throughout, and the rest of the findings, including those from the sensory evaluation, were unremarkable. Computed tomography (CT) showed a cystic
suprasellar lesion and a small area of decreased attenuation in the posterior limb of the left internal capsule
(Figure 1). Magnetic resonance imaging (MRI) confirmed the left capsular infarction as well as the

Discussion
PMH is a heterogeneous syndrome caused by a
variety of pathologic processes affecting the pyramidal motor pathway at both the supratentorial and
infratentorial levels.•-•' While in some cases PMH has
been the result of a space-occupying mass,7-10 in most
patients PMH is caused by a small infarction due to
the occlusion of a terminal vessel.1-6 Such occlusion
may be secondary to atherosclerosis3 or chronic meningitis, inducing inflammatory arteriopathies."
Meningeal cysticercosis is a well-recognized cause
of ischemic cerebrovascular disease.12 In these cases,
abnormal thickening of leptomeninges at the base of
the skull accounts for inflammatory changes in the
wall of blood vessels around the circle of Willis.
Those vessels show thickening of the adventitia
with fibrosis of the media and endothelial
hyperplasia13; in some instances this process of
endarteritis leads to complete occlusion of a blood
vessel, with subsequent brain infarction.13-15
In our patient the diagnosis of cysticercosis was
made on the basis of CT findings and positive
immunologic reactions in the CSF. 1617 In addition,
MRI provided direct evidence of arachnoiditis in
the suprasellar cistern, which could account for the

From the Division de Neurologia, Instituto National de Neurologia y Neurocirugia, Mexico City, Mexico.
Address for correspondence: Fernando Barinagarrementeria,
MD, Instituto Nacional de Neurologia y Neurocirugia, Insurgentes Sur 3877, 14410, Mexico 22, DF, Mexico.
Received February 22, 1988; accepted March 31, 1988.

Barinagarrementeria and Del Brutto Pure Motor Hemiparesis

1157

FIGURE 1. Contrast-enhanced computed tomogram showing (left) small infarction in posterior limb of left internal
capsule and (right) cystic suprasellar lesion consistent with cysticercus (arrow).
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FIGURE 2. Left: Tl-weighted (echo time 520 msec, repetition time 21 msec) magnetic resonance image showing left
capsular infarction. Right: T2-weighted (echo time 2000 msec, repetition time 50 msec) magnetic resonance image
showing suprasellar cysticercus (large arrow) with surrounding arachnoiditis (small arrows).

1158

Stroke Vol 19, No 9, September 1988

occlusion of a small terminal vessel supplying the
left internal capsule. This case, together with previous reports, 121415 points out that cysticercosis is
a possible cause of cerebral infarction and stresses
the importance of CSF analysis in patients with
lacunar syndromes who come from areas of the
world in which cysticercosis is endemic.18-20
References
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KEY WORDS

hemiplegia

cerebral infarction

cysticercosis

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