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Starry sky appearance
  1. K S Sodhi,
  2. N Khandelwal,
  3. S Suri
  1. Department of Radiodiagnosis and Imaging, Postgraduate Institute Of Medical Education And Research, Chandigarh, India
  1. Correspondence to:
 Dr K S Sodhi
 Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh 160012, India;

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A 18 year old woman presented with a two month history of headache and two episodes of seizures in the past. On examination, she was afebrile, had no focal signs and no neurological deficit.

Computed tomography showed multiple intracranial hyperdense focii (calcifications), seen diffusedly distributed in both the cerebral and cerebellar hemispheres (fig 1). No evidence of any perilesional oedema or midline shift was seen. These widespread intra-parenchymal calcifications, giving a starry sky appearance on computed tomography are consistent with a diagnosis of neurocysticerosis.

Figure 1

 Computed tomography shows multiple intracranial calcifications, in both the cerebral and cerebellar hemispheres.

Cysticercosis is the most common parasitic disease involving the brain. It is seen in both immuno-suppressed and immuno-competent people from endemic regions. It is caused by ingesting the ova of the pork tape worm (Taenia solium), through unwashed faecally contaminated vegetables or water. Humans are the inter-mediate hosts of Taenia solium. The location of involvement in brain can be parenchymal, intra-ventricular, or meningobasal. The diagnosis of cysticercosis is based on clinical, radiological, and serological indicators. Treatment is mostly medical (praziquantel), however surgical treatment may be required if ventricular obstruction is present.