Persistent MRI Abnormalities After Successful Treatment of Subarachnoid and Intraventricular Neurocysticercosis: A Case Series.

Objectives: To describe the neuroimaging findings of patients after successful antiparasitic treatment for subarachnoid and intraventricular neurocysticercosis (NCC). Methods: In this retrospective case series, we reviewed brain MRIs for 6 patients cared for between 2015 and 2021 with confirmed subarachnoid or intraventricular NCC who were successfully treated, defined as a negative Taenia solium antigen and quantitative PCR from CSF. Results: On post-treatment MRIs obtained between 0 months and over 4 years after completion of therapy, all patients had persistently abnormal neuroimaging findings, including residual enhancing cysts and leptomeningeal and vascular enhancement, despite continued clinical improvement. Discussion: Persistent post-treatment MRI abnormalities are common in patients with NCC and do not necessarily warrant additional antiparasitic therapy. Although MRI remains a valuable tool for assessing overall treatment response, complete normalization of neuroimaging findings is uncommon in subarachnoid and intraventricular NCC.