NEUROCYSTICERCOSIS (NCC) — CASE RECOGNITION FLOWCHART

NEUROCYSTICERCOSIS (NCC) — CASE RECOGNITION FLOWCHART
When to suspect and how to follow up on possible NCC-related fatal cases

1. Death with history of:

   • New or unexplained seizures/epilepsy (especially adult-onset)

   • Fatal brain infection, meningoencephalitis, encephalitis

   • Hydrocephalus, intracranial hypertension, unexplained coma

   • Hemorrhagic or ischemic stroke, cerebral edema

   • Sudden unexplained neurological deterioration

2. Review the following:

   • Exposure risk factors:

     • Residence in or travel to NCC-endemic areas (Latin America, India, Southeast Asia, Sub-Saharan Africa)

     • Recent or frequent consumption of street food (taco trucks, informal vendors), undercooked pork

     • Close contact with anyone from endemic regions, or suspected tapeworm carrier

   • No other clear cause identified after routine work-up

3. Next steps:

   • Review neuroimaging:

     • Cystic, ring-enhancing, or calcified brain lesions

     • Hydrocephalus or unusual patterns of brain edema

   • Tissue diagnosis:

     • If autopsy or biopsy available, look for cysticercal cysts/larvae

4. Laboratory tests:

   • Consider serology for T. solium (ELISA/EITB) if stored serum available

   • Histologic exam of brain tissue for cysticerci (if specimens possible)

5. Documentation:

   • List “neurocysticercosis” as a cause or significant contributor if evidence supports

   • Record risk factors and any suggestive findings in summary

6. Public health follow-up:

   • Notify authorities for possible source tracing, family/household screening

   • Highlight “possible local transmission” if no foreign travel noted

REMEMBER:
NCC can occur in any ethnicity; exposure to contaminated food/handlers is sufficient. Consider in unexplained neuro deaths—especially with adult-onset seizures or atypical brain imaging.