Cysticercal meningitis--a pernicious form of neurocysticercosis which responds poorly to praziquantel.

Chronic cysticercal meningitis was diagnosed in 6 of 260 cases of neurocysticercosis. Clinical features usually associated with meningitis, such as fever, cranial nerve palsies and nuchal rigidity, were absent and the diagnosis was reached because of persistently abnormal cerebrospinal fluid (CSF) associated with active neurocysticercosis on computed tomography. Other causes of chronic meningitis were excluded. Hydrocephalus, either obstructive or communicating, was present in all 6 patients. The results of medical treatment with praziquantel were poor and there was no improvement either clinically or in the CSF. Severe clinical sequelae, such as dementia, blindness and gait ataxia, were common despite protracted medical treatment and ventriculoperitoneal shunting.