Anterior cerebral artery territory infarction in neurocysticercosis: evaluation by MR angiography and in vivo proton MR spectroscopy.

Vascular complications of neurocysticercosis are common, but frequently not recognized. Mostly these are in the form of an endarteritis involving the smaller basal vessels due to basal exudates. Large vessel territory infarction has been clearly documented in not more than 10 cases. All these cases had either a chronic meningeal state or close proximity of cysts to the vessel wall explaining the vasculitis. We report a case that developed anterior as well as segmental middle cerebral artery territory infarction in the acute encephalitic state of neurocysticercosis. MR angiography showed constriction in the proximal segment of the right anterior cerebral artery. There was no biochemical or imaging evidence of a meningeal reaction. In vivo MR spectroscopy over the infarction showed absent N-acetyl-aspartate, low creatine and high lactate. This is the first case showing a large vessel territory infarction in the encephalitic state of neurocysticercosis, with no meningeal reaction. Focal arteritis due to an adjacent brain parenchymal reaction could be a possible mechanism for the vasculitis. MR spectroscopy may have a potential role in assessing tissue viability and therapeutic modalities in such infective vasculitis.