A 47-year-old male presented in ER with status epilepticus. One year before that, he began to suffer from recurrent headache and seizures. Twenty years ago, he had brain CT performed after one episode of seizure. It revealed multiple calcifications and anthelmintic treatment was administered for suspected neurocysticercosis. He remained seizure-free until last year. From then on, albendazole and praziquantel were readministered but to no avail. Prednisone 20 mg daily reduced the frequency of seizures. However, when prednisone stopped, seizures rebounded.
Head CT and MRI were both performed after each seizure episode. Multiple calcified lesions were revealed by head CT (Fig. a). Interestingly enough, although brain oedema waxed and waned on MRI over time, calcified lesions remained unchanged and oedemas on MRI always transpired around the calcifications (Fig. b-e). Empirical corticosteroid treatment lead to complete resolving of brain oedemas (Fig. f), however, they reappeared after cessation of corticosteroid (Fig. g, h).
Symptoms related to calcified neurocysticercosis are mostly seizures, but can also be headaches or focal neurological abnormalities, such as aphasia, confusion, or flashing/moving lights.  Asymptomatic perilesional oedema was reported. Anti-seizure medications are the mainstay of treatment. The use of corticosteroids in short term may be justified but long-term use is not recommended since corticosteroids withdrawal can lead to symptomatic episodes. [3, 4]
Actually, intermittent appearance of perilesional oedema around calcified neurocysticercosis is not uncommon. In a cohort of 24 patients with calcified lesions and seizures, MRI detected perilesional oedema in 12 (50%).  Oedema usually resolves spontaneously in 4-6 weeks. The predictors include the number of enhancing calcified cysts and scolex seen on MRI. 
Low dose of dexamethasone and levetiracetam 1000 mg daily were used during admission. After discharge, levetiracetam was reserved but corticosteroid was tapered. The patient had one episode of simple partial seizure each month. Several months after discharge, the patient received brain biopsy. Histopathology showed the corpus of Taenia solium (Fig. 2). No adjustment was made to the treatment since the parasites were dead. He still suffered from occasional seizures after the operation.
 Ooi WW, Wijemanne S, Thomas CB, Quezado M, Brown CR, Nash TE. Short report: A calcified Taenia solium granuloma associated with recurrent perilesional edema causing refractory seizures: histopathological features. Am J Trop Med Hyg. 2011;85(3):460-3. Epub 2011/09/08. doi: 10.4269/ajtmh.2011.11-0221. (PMID: 21896805)
 Nash TE, Pretell EJ, Lescano AG, Bustos JA, Gilman RH, Gonzalez AE, et al. Perilesional brain oedema and seizure activity in patients with calcified neurocysticercosis: a prospective cohort and nested case-control study. Lancet Neurol. 2008;7(12):1099-105. Epub 2008/11/07. doi: 10.1016/S1474-4422(08)70243-6. (PMID: 18986841)
 Nash T. Edema surrounding calcified intracranial cysticerci: clinical manifestations, natural history, and treatment. Pathog Glob Health. 2012;106(5):275-9. Epub 2012/12/26. doi: 10.1179/2047773212Y.0000000026. PubMed PMID: 23265551; PubMed Central PMCID: PMCPMC4005110.
 Mejia R, Nash TE. Corticosteroid withdrawal precipitates perilesional edema around calcified Taenia solium cysts. Am J Trop Med Hyg. 2013;89(5):919-23. Epub 2013/09/05. doi: 10.4269/ajtmh.13-0350. (PMID: 24002482)