{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T19:00:50Z","timestamp":1790103650926,"version":"4.0.1"},"reference-count":31,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Extraparenchymal neurocysticercosis, caused by Taenia solium, is an uncommon form of neurocysticercosis involving the subarachnoid space and ventricular system. Clinical manifestations are heterogeneous, including seizures, meningitis, and intracranial hypertension, and are often associated with worse outcomes. Diagnosis remains challenging, as cysts may be difficult to detect on conventional imaging due to signal characteristics similar to cerebrospinal fluid, frequently leading to inconclusive results. We describe a patient presenting with a six-month history of focal seizures in whom the diagnosis was established following surgical excision of a cystic lesion, with definitive confirmation provided by positive PCR detection of T. solium nuclear ribosomal DNA in the excised tissue. The patient received 14 days of dual antiparasitic therapy and remained free of neurological symptoms during 12 months of follow-up. This case highlights the potential limitations of noninvasive diagnostic modalities and the challenges that physicians might encounter when evaluating infectious diseases that are not endemic to their country of practice. It also underscores the value of a structured diagnostic approach, as recommended by several international health bodies, complemented by advanced molecular techniques such as PCR. Overall, it provides a clinically relevant illustration of key diagnostic challenges and decision-making steps in the evaluation of this complex condition.<\/jats:p>","DOI":"10.3390\/pathogens15090996","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T17:56:41Z","timestamp":1790099801000},"page":"996","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["PCR-Confirmed Convexity Subarachnoid Neurocysticercosis with Negative Serology: A Case Report"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6567-1999","authenticated-orcid":false,"given":"Aristos","family":"Aristodimou","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Limassol General Hospital, State Health Organization Services, Limassol 4131, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4798-9203","authenticated-orcid":false,"given":"Zacharias","family":"Raptopoulos","sequence":"additional","affiliation":[{"name":"Family Medicine Residency Program, Limassol General Hospital, State Health Organization Services, Limassol 4131, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3737-7664","authenticated-orcid":false,"given":"Jan","family":"Richter","sequence":"additional","affiliation":[{"name":"Molecular Virology Department, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Tryfonos","sequence":"additional","affiliation":[{"name":"Molecular Virology Department, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Dimitriadi","sequence":"additional","affiliation":[{"name":"Pathology Department, Nicosia General Hospital, State Health Organization Services, Nicosia 2029, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moises Akis","family":"Lamprou","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Nicosia General Hospital, State Health Organization Services, Nicosia 2029, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3057-0568","authenticated-orcid":false,"given":"Loizos","family":"Siakallis","sequence":"additional","affiliation":[{"name":"Medical School, University of Cyprus, Nicosia 2029, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Del Brutto, O.H. (2022). Human Neurocysticercosis: An Overview. Pathogens, 11.","DOI":"10.3390\/pathogens11101212"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e49","DOI":"10.1093\/cid\/cix1084","article-title":"Diagnosis and Treatment of Neurocysticercosis: 2017 Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH)","volume":"66","author":"White","year":"2018","journal-title":"Clin. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Zammarchi, L., Strohmeyer, M., Bartalesi, F., Bruno, E., Mu\u00f1oz, J., Buonfrate, D., Nicoletti, A., Garcia, H.H., Pozio, E., and Bartoloni, A. (2013). Epidemiology and Management of Cysticercosis and Taenia solium Taeniasis in Europe, Systematic Review 1990\u20132011. PLoS ONE, 8.","DOI":"10.1371\/annotation\/1bcc3e5b-1159-412b-be86-b18d94515cc2"},{"key":"ref_4","first-page":"78","article-title":"Current status of food-borne parasitic zoonoses in West Germany","volume":"22","author":"Hinz","year":"1991","journal-title":"Southeast Asian J. Trop. Med. Public Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2415","DOI":"10.1016\/S0140-6736(24)02356-0","article-title":"Neurocysticercosis school outbreak in Belgium","volume":"404","author":"Driessche","year":"2024","journal-title":"Lancet"},{"key":"ref_6","unstructured":"Centers for Disease Control and Prevention (2026, April 04). Cysticercosis, DPDx\u2014Laboratory Identification of Parasites of Public Health Concern [Internet], Available online: https:\/\/www.cdc.gov\/dpdx\/cysticercosis\/index.html."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"333","DOI":"10.2147\/IJGM.S73249","article-title":"Managing Neurocysticercosis: Challenges and solutions","volume":"8","author":"Fogang","year":"2015","journal-title":"Int. J. Gen. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1038\/nrneurol.2011.135","article-title":"Diagnosis and treatment of Neurocysticercosis","volume":"7","author":"Nash","year":"2011","journal-title":"Nat. Rev. Neurol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Bazan, R., Filho, P.T.H., Luvizutto, G.J., Ruben\u2019s de Carvalho Nunes, H., Odashima, N.S., Dos Santos, A.C., J\u00fanior, J.E., Zanini, M.A., Fleury, A., and Takayanagui, O.M. (2016). Clinical Symptoms, Imaging Features and Cyst Distribution in the Cerebrospinal Fluid Compartments in Patients with Extraparenchymal Neurocysticercosis. PLoS Negl. Trop. Dis., 10.","DOI":"10.1371\/journal.pntd.0005115"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.jns.2016.11.045","article-title":"Revised diagnostic criteria for Neurocysticercosis","volume":"372","author":"Nash","year":"2017","journal-title":"J. Neurol. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1007\/s00234-005-0024-5","article-title":"Pattern of T2 hypointensity associated with ring-enhancing brain lesions can help to differentiate pathology","volume":"48","author":"Schwartz","year":"2006","journal-title":"Neuroradiology"},{"key":"ref_12","first-page":"61","article-title":"Ring-Enhancing Lesions in the Brain: A Diagnostic Dilemma","volume":"8","author":"Shetty","year":"2014","journal-title":"Iran. J. Child Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ng-Nguyen, D., Stevenson, M.A., Dorny, P., Gabri\u00ebl, S., Van Vo, T., Nguyen, V.-A.T., Van Phan, T., Hii, S.F., and Traub, R.J. (2017). Comparison of a new multiplex real-time PCR with the Kato Katz thick smear and copro-antigen ELISA for the detection and differentiation of Taenia spp. in human stools. PLoS Negl. Trop. Dis., 11.","DOI":"10.1371\/journal.pntd.0005743"},{"key":"ref_14","first-page":"67","article-title":"Neurocysticercosis: A Review into Treatment Options, Indications, and Their Efficacy","volume":"13","author":"Filho","year":"2022","journal-title":"Res. Rep. Trop. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"191","DOI":"10.21608\/jesp.2025.447393","article-title":"Neurocysticercosis: The first case report in Cyprus","volume":"55","author":"Aristodimou","year":"2025","journal-title":"J. Egypt. Soc. Parasitol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1097\/WNO.0000000000001782","article-title":"Atypical Presentations of Extraparenchymal Neurocysticercosis","volume":"43","author":"Fan","year":"2023","journal-title":"J. Neuro-Ophthalmol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1002\/ana.24732","article-title":"New diagnostic criteria for neurocysticercosis: Reliability and validity","volume":"80","author":"Carpio","year":"2016","journal-title":"Ann. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1038\/nrneurol.2016.145","article-title":"Diagnostic criteria for Neurocysticercosis\u2014A difficult update","volume":"12","author":"Gilman","year":"2016","journal-title":"Nat. Rev. Neurol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1111\/tmi.13010","article-title":"Low sensitivity and frequent cross-reactions in commercially available antibody detection ELISA assays for Taenia solium cysticercosis","volume":"23","author":"Garcia","year":"2018","journal-title":"Trop. Med. Int. Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1128\/JCM.01554-10","article-title":"Human neurocysticercosis: Comparison of different diagnostic tests using cerebrospinal fluid","volume":"49","author":"Michelet","year":"2011","journal-title":"J. Clin. Microbiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2891","DOI":"10.1007\/s00436-019-06425-4","article-title":"Immunodiagnosis of human neurocysticercosis: Comparative performance of serum diagnostic tests in Mexico","volume":"118","author":"Astudillo","year":"2019","journal-title":"Parasitol. Res."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Jaspers, E., Byblow, W.D., Feys, H., and Wenderoth, N. (2016). The corticospinal tract: A biomarker to categorize upper limb functional potential in unilateral cerebral palsy. Front. Pediatr., 3.","DOI":"10.3389\/fped.2015.00112"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1016\/S1474-4422(08)70243-6","article-title":"Perilesional brain oedema and seizure activity in patients with calcified neurocysticercosis: A prospective cohort and nested case\u2013control study","volume":"7","author":"Nash","year":"2008","journal-title":"Lancet Neurol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1002\/epi4.12324","article-title":"Intermittent perilesional edema and contrast enhancement in epilepsy with calcified neurocysticercosis may help to identify the seizure focus","volume":"4","author":"Yasuda","year":"2019","journal-title":"Epilepsia Open"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Fan, S., Qiao, X., Liu, L., Wu, H., Zhou, J., Sun, R., Chen, Q., Huang, Y., Mao, C., and Yuan, J. (2018). Next-Generation Sequencing of Cerebrospinal Fluid for the Diagnosis of Neurocysticercosis. Front. Neurol., 9.","DOI":"10.3389\/fneur.2018.00471"},{"key":"ref_26","first-page":"299","article-title":"Diagnostic criteria for neurocysticercosis, revisited","volume":"106","year":"2012","journal-title":"Ann. Trop. Med. Parasitol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.actatropica.2015.08.017","article-title":"Relevance of 3D magnetic resonance imaging sequences in diagnosing basal subarachnoid neurocysticercosis","volume":"152","author":"Mezo","year":"2015","journal-title":"Acta Trop."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e324","DOI":"10.1212\/NXI.0000000000000324","article-title":"Validity of a PCR assay in CSF for the diagnosis of Neurocysticercosis","volume":"4","author":"Carpio","year":"2017","journal-title":"Neurol.-Neuroimmunol. Neuroinflamm."},{"key":"ref_29","first-page":"8887647","article-title":"Neurocysticercosis Diagnosed by Taenia solium PCR on Brain Biopsy","volume":"2020","author":"Ong","year":"2020","journal-title":"Case Rep. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.12659\/AJCR.910729","article-title":"Dual Cestode Infection in a Thai Patient (Spinal Sparganosis and Racemose Neurocysticercosis): A Case Report","volume":"19","author":"Chotmongkol","year":"2018","journal-title":"Am. J. Case Rep."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Lordick, F., Trawinski, H., and L\u00fcbbert, C. (2026). Occurrence of autochthonous neurocysticercosis in Germany: A case report. BMC Infect. Dis., 26.","DOI":"10.1186\/s12879-026-12859-w"}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/9\/996\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:06:05Z","timestamp":1790100365000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/9\/996"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,21]]},"references-count":31,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["pathogens15090996"],"URL":"https:\/\/doi.org\/10.3390\/pathogens15090996","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,21]]}}}