Brain under Parasitic Siege — A Comprehensive Descriptive Review of Neuroparasitic Diseases

Abstract

Parasitic infections of the central nervous system (CNS) represent a significant yet frequently under-recognised cause of neurological morbidity and mortality worldwide. These infections are caused by a diverse range of protozoa, helminths, and free-living amoebae and may lead to acute or chronic neurological manifestations through mechanisms including direct neural invasion, immune-mediated inflammation, vascular compromise, and blood–brain barrier disruption. Clinically, neuroparasitic diseases present with a broad spectrum of symptoms, ranging from seizures and focal neurological deficits to encephalopathy, cognitive impairment, and coma. This narrative review synthesises current evidence published between 2000 and 2025 regarding the pathophysiology, clinicopathological features, diagnostic approaches, and management strategies of major neuroparasitic diseases, including cerebral malaria, neurocysticercosis, neurotoxoplasmosis, human African trypanosomiasis, and amoebic encephalitis. Emphasis is placed on integrating clinical presentation with histopathological and neuroimaging findings to support diagnostic reasoning and therapeutic decision-making. Advances in diagnostic methodologies, including molecular techniques, magnetic resonance imaging, and computed tomography are discussed, alongside emerging perspectives on the potential role of artificial intelligence (AI) in diagnostic support and epidemiological modelling. By consolidating dispersed evidence into a unified framework, this review aims to serve as an educational and interdisciplinary reference for clinicians and researchers encountering neuroparasitic diseases in neurological practice.