Neurology: cysticercal encephalitis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Neurology: cysticercal encephalitis

Sample item

A 19-year-old man has headache, repeated vomiting, seizures and papilloedema. CT shows hundreds of small enhancing lesions scattered throughout the brain, giving a starry-sky appearance. He has a history of eating pork in a village. What is the most appropriate initial management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Corticosteroids and measures to lower intracranial pressure, deferring albendazole

Massive neurocysticercosis with raised intracranial pressure is cysticercal encephalitis. Killing many larvae at once provokes an intense inflammatory response and fatal cerebral oedema, so corticosteroids and osmotic agents are given first and cysticidal drugs are delayed until the pressure is controlled. Antiseizure drugs are added.

Option by option

  • A. Albendazole alone, started immediately

    Immediate cysticidal drugs can cause acute swelling, so albendazole alone is dangerous here.

  • B. Surgical excision of the lesions

    Hundreds of lesions cannot be excised, and surgery is for obstructing intraventricular cysts.

  • C. Praziquantel without corticosteroids

    Praziquantel without steroids carries the same inflammatory risk as albendazole alone.

  • D. Corticosteroids and measures to lower intracranial pressure, deferring albendazole (correct)

    Correct. Controlling inflammation and pressure first prevents catastrophic oedema.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Corticosteroids and measures to lower intracranial pressure, deferring albendazole. Massive neurocysticercosis with raised intracranial pressure is cysticercal encephalitis.

Why is "Albendazole alone, started immediately" not the answer?

Immediate cysticidal drugs can cause acute swelling, so albendazole alone is dangerous here.

Why is "Surgical excision of the lesions" not the answer?

Hundreds of lesions cannot be excised, and surgery is for obstructing intraventricular cysts.

Why is "Praziquantel without corticosteroids" not the answer?

Praziquantel without steroids carries the same inflammatory risk as albendazole alone.

What concept does this question test?

It tests Neurology: cysticercal encephalitis in General Medicine. Killing many larvae at once provokes an intense inflammatory response and fatal cerebral oedema, so corticosteroids and osmotic agents are given first and cysticidal drugs are delayed until the pressure is controlled. Antiseizure drugs are added.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neurology: cysticercal encephalitis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.