Background: Calcified cysticerci share the morphology and signal properties with true cerebral microbleeds, but this condition is neglected at the time of evaluating MRIs for clinical or research purposes. We report our experience with the MRI reading obtained from the Atahualpa Project, a population-based stroke study, conducted in a village endemic for cysticercosis. Methods: Neuroimaging studies were performed in Atahualpa residents aged =60 years identified during a door-to-door survey. Lesions of interest included neuroimaging markers of small vessel disease. Out of 311 residents, 248 (80%) agreed to participate. Two internal readers independently reviewed MRIs blinded to CT findings. Results: Internal readers achieved good-to-very-good inter-rater agreements for all types of investigated lesions, with the exception of cortical microbleeds (κ = 0.53). After reviewing CTs, six of eight conflicting lesions were cysticercus. Five external experts blinded to CT findings also read those images, reporting conflicting results. Cysticercosis was recognized only in 26% of readings. Conclusion: Calcified cysticercotic lesions should be included in the list of microbleed mimics. CT should be performed in doubtful cases to avoid overdiagnosis of cerebral microbleeds in large-scale stroke studies and in the clinical practice. Proper recognition of this neglected microbleed mimic may have important therapeutic implications.

Keywords:
Cysticercosis, Neurocysticercosis, Intracranial calcifications , Cerebral microbleed, Microbleed mimics
1.
Yates PA, Villemagne VL, Ellis KA, Desmond PM, Masters CL, Rowe CC: Cerebral microbleeds: a review of clinical, genetic, and neuroimaging associations. Front Neurol 2014;4:205.
2.
Samarasekera N, Potter G, Salam AS: Cerebral microbleed mimics; in Werring DJ, (ed): Cerebral microbleeds. Cambridge, UK: Cambridge University Press, 2011, pp 44-48.
3.
Nash TE, Del Brutto OH, Butman JA, Corona T, Delgado-Escueta A, Duron RM, et al: Calcific neurocysticercosis and epileptogenesis. Neurology 2004;62:1934-1938.
4.
Del Brutto OH, Peñaherrera E, Ochoa E, Santamaria M, Zambrano M, Del Brutto VJ: Door-to-door survey of cardiovascular health, stroke, and ischemic heart disease in rural coastal Ecuador - the Atahualpa Project: methodology and operational definitions. Int J Stroke 2014;9:367-371.
5.
Del Brutto OH: Implications and expectancies of the ‘Atahualpa Project': a population-based survey designed to reduce the burden of stroke and cardiovascular diseases in rural Ecuador. J Neurosci Rural Pract 2013;4:363-365.
6.
Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, et al: Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 2013;12:822-838.
7.
Thomas B, Somasundaran S, Thamburaj K, Kesavadas C, Gupta AK, Bodhey NK, et al: Clinical applications of susceptibility weighted MR imaging of the brain - a pictorial view. Neuroradiology 2008;50:105-116.
© 2014 S. Karger AG, Basel
2014
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