Bruns' syndrome and racemose neurocysticercosis: a case report / Síndrome de Bruns e neurocisticercose racemosa: relato de caso

Cysticercosis is an infection caused by the larval stage of the tapeworm Taenia solium. The parasite may infect the central nervous system, causing neurocysticercosis (NCC). The clinical manifestations depend on load, type, size, location, stage of development of the cysticerci, and the host's immune response against the parasite. The racemose variety occurs in the ventricles or basal cisterns and is a malignant form. Mobile ventricular mass can produce episodic hydrocephalus on changing head posture with attacks of headache, vomiting, and vertigo, triggered by abrupt movement of the head, a phenomenon called Bruns' syndrome (BS). We report a patient with racemose NCC and BS.

A infecção por cisticercose é causada pelo estágio larval da Taenia solium. O parasita pode infectar o sistema nervoso central, causando neurocisticercose (NCC). As manifestações clínicas dependem da quantidade, tipo, tamanho, local, estágio de desenvolvimento do cisticerco e resposta imune do hospedeiro contra o parasita. A variedade racemosa ocorre nas cisternas ventriculares ou basais e é considerada uma forma maligna. O cisticerco móvel no ventrículo pode produzir hidrocefalia episódica com ataques de cefaléia, vômitos e vertigem, provocados pelo movimento abrupto da cabeça, fenômeno chamado de síndrome de Bruns (SB). Relataremos o caso de uma paciente com NCC racemosa com SB.

Unusual presentations of malaria in children: an experience from a tertiary care centre in north east India.

Objective. To identify cases of malaria with unusual presentations. Methods. The medical record of all the cases of malaria admitted to PICU and pediatric general ward from Oct 2006 to Sep 2009, were reviewed and cases with unusual presentations were identified. The study design was retrospective descriptive study. Results. Sixteen (10%) out of 162 malaria cases had unusual presentations - three had hemiplegia, two each with viral hepatitis-like presentation, acute abdomen, gastrointestinal bleed, generalized edema and hyperglycemia and one each with ptosis, severe headache and subacute intestinal obstruction-like presentation. Eleven cases had mixed parasitemia and two each with P. vivax and P. falciparum. One case was diagnosed on clinical grounds. Conclusions. Malaria is a common disease, but both typical and atypical presentations deserve attention for early diagnosis and management.

Aspectos clínicos e evolutivos da hidrocefalia na neurocisticercose / Clinical and evolutive aspects of hydrocephalus in neurocysticercosis

Com o propósito de analisar os aspectos clínicos da hidrocefalia (HDC) na neurocisticercose (NCC), realizou-se o estudo retrospectivo de 47 prontuários de pacientes com HDC e NCC. Verificou-se que 70,2 por cento eram homens, entre 21 e 50 anos. A hipertensão intracraniana (HIC) ocorreu em todos os pacientes, cefaléia (CEF) em 89,4 por cento, meningoencefalite (ME) em 80,8 por cento e distúrbios psíquicos (PSI) em 74,5 por cento. A síndrome liquórica da NCC foi detectada em 65,9 por cento pacientes. Além da HDC, as tomografias computadorizadas de crânio (TC) mostraram lesões císticas e edema cerebral difuso em 59,6 por cento cada, calcificações em 55,3 por cento. Dos 41 pacientes (87,2 por cento) com derivação ventriculoperitoneal (DVP), em 22 (53,7 por cento) deles foram necessárias uma a sete revisões/paciente (média=3). A evolução foi satisfatória em 51,1 por cento e fatal em 31,9 por cento. Conclui-se que a hidrocefalia é mais comum no sexo masculino em idade produtiva, tendo a HIC, CEF, MN e PSI como manifestações freqüentes e que, a necessidade de revisões de DVP, piora o prognóstico.

With the purpose to verify clinical aspects of hydrocephalus (HC) in patients with neurocysticercosis (NCC), a retrospective study of 47 patients was performed. The majority of patients (70.2 percent) were men aging 21-50 years. Intracranial hypertension (ICH) occurred in all patients, headache (HA) in 42 (89.4 percent), meningoencephalitis (ME) in 38 (80.8 percent) and psychiatric disorders (PD) in 34 (72.3 percent). The cerebrospinal fluid syndrome of NCC was detected in 31 patients (65.9 percent). In addition to HC, computed tomography (CT) scans showed cystic lesions in 28 (59.6 percent) patients, diffuse brain edema also in 28 (59.6 percent), and calcifications in 26 (55.3 percent). Shunts were inserted in 41 (87.2 percent) patients and 22 (53.7 percent) of them were submitted to 1-7 surgical revision/patient (mean=3) that were higher (mean=4) in those who died than in survivors (mean=2). Evolution was satisfactory in 24 (51.1 percent) patients and fatal in 15 (31.9 percent). It is possible to conclude that, in patients with NCC, HC occurs predominantly in men in productive life with ICH, HA, ME and PD as common manifestations, and the need for shunt revision makes patient's prognosis worse.

The clinical and epidemiological features of childhood malaria in a moderately endemic area of Sri Lanka.

This study describes some clinical and epidemiological features of childhood malaria in a moderately endemic area of southern Sri Lanka. Six hundred and sixty-two children, who experienced 1,138 attacks of malaria, and 172 children, who experienced 202 attacks of acute non-malarial fever, were followed over a period of two years. Of the 1,138 malaria infections followed, 776 were due to P. vivax, 359 were due to P. falciparum, and 3 were mixed infections. The majority of children presented within the first three days of the onset of symptoms. Headache (96%), feeling cold (81%) and arthralgia (77%) were the commonest presenting symptoms. Two hundred and sixty-four children experienced more than one attack of malaria. The clinical and epidemiological features of childhood malaria that have important implications for the planning and targeting of preventive measures are discussed.