1327. The Diagnosis of Subarachnoid Neurocysticercosis Is Often Delayed And Other Findings of a Multicenter Retrospective in the USA

BACKGROUND: Subarachnoid (racemose) neurocysticercosis (SANCC) is an uncommon but severe form of Taenia solium infection. There is limited evidence to guide clinical management of these patients. METHODS: We performed a multicenter retrospective chart review of 15 U.S. sites. A total of 69 subjects with racemose disease were entered. RESULTS: The most common region of exposure was Mexico (67%) followed by Central America (24%). Median age was 43 years (range 15-76) and 71% were male. Common symptoms at the time of index admission were headache (80%), nausea/vomiting (46%), dizziness (44%), and blurry vision (33%). Cysts were intracranial in 64 (93%) subjects and exclusively intraspinal in 4. One patient had meningitis without visible cystic lesions. Incident admission magnetic resonance imaging (MRI) demonstrated ventriculomegaly in 41 (59%) and focal findings in 9 (13%) including ischemic infarct, subarachnoid hemorrhage, and/or arterial aneurysm. For 55 (80%), SANCC was first diagnosed during the index admission. Of these, 23 (42%) had prior medical visits and substantial delay in diagnosis (i.e. previously seen with hydrocephalus [27%], stroke [5.5%], and/or meningitis [11%], missed diagnostic radiologic features [4%], or inadequate imaging [5.5%]). Of the 69 subjects, 54% underwent a neurosurgical procedure during index admission (cyst removal n=16, EVD/shunt/ventriculostomy n=24). At the time of discharge, 6 (8.6%) patients were not given albendazole and/or praziquantel due to cost or availability. Six months following discharge, < 10% of follow up MRIs demonstrated cyst resolution. Planned treatment course of < 4 weeks at discharge compared to >4 weeks was associated with increased risk for new cyst development on follow up imaging at a median of 3.8 years following discharge (range 2.6 months-8 years). Those with a delayed diagnosis received a significantly longer duration of corticosteroids (median 8 weeks) than those without a delay (median 5 weeks, p=0.047). CONCLUSION: The diagnosis of SANCC is often missed, and most patients require neurosurgical intervention. Antiparasitic therapy is suboptimal, especially with regimens developed for parenchymal NCC. DISCLOSURES: Jeffrey D. Jenks, MD, MPH, Astellas: Grant/Research Support|F2G: Grant/Research Support|Pfizer: Grant/Research Support