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Objective To analyze the clinical characteristics of 24 patients with cysticercosis of the fourth ventricle, and to evaluate the therapeutic efficacy of microsurgery. Methods The clinical data of 24 patients with cysticercosis of the fourth ventricle referred the Department of Neurosurgery of the Affiliated Hospital of Qinghai University from January 2000 to December 2018 were collected, and the clinical features, imaging characteristics, surgical methods, therapeutic efficacy and postoperative complications were analyzed. Results The 24 patients included 15 men and 9 women, and had a mean age of 43.5 years (range, 16 to 68 years). Preoperative imaging examinations showed obvious dilatation of bilateral lateral ventricles, the third ventricle and middle cerebral aqueduct, and spherical or cystic dilatation of the fourth ventricle. There were 18 cases positive for antibodies against cysticercus, and 3 of the 21 cases were egg positives. All 24 cases received microsurgery, including 8 cases via the median aperture approach, 7 cases via the median aperture-cerebellar vermis approach, and 9 cases via the transcerebellomedullary fissure approach. There were 17 cases with complete delivery of vesicles, 5 cases with vesicle rupture and 2 cases with extraction of cystic fluid followed by separation and removal of cystic wall. All cases had obvious retraction of the ventricular system and disappearance of intracranial hypertension following surgery. There were 19 cases (79.17%) with well recovery, and 5 cases (20.83%) with aggravation or development of cerebellar ataxia, which recovered following treatment for 1 to 2 weeks. Conclusion The transcerebellomedullary fissure approach is a safe and lowly invasive approach for the treatment of cysticercosis of the fourth ventricle.
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Objective To analyze the clinical characteristics of 24 patients with cysticercosis of the fourth ventricle, and to evaluate the therapeutic efficacy of microsurgery. Methods The clinical data of 24 patients with cysticercosis of the fourth ventricle referred the Department of Neurosurgery of the Affiliated Hospital of Qinghai University from January 2000 to December 2018 were collected, and the clinical features, imaging characteristics, surgical methods, therapeutic efficacy and postoperative complications were analyzed. Results The 24 patients included 15 men and 9 women, and had a mean age of 43.5 years (range, 16 to 68 years). Preoperative imaging examinations showed obvious dilatation of bilateral lateral ventricles, the third ventricle and middle cerebral aqueduct, and spherical or cystic dilatation of the fourth ventricle. There were 18 cases positive for antibodies against cysticercus, and 3 of the 21 cases were egg positives. All 24 cases received microsurgery, including 8 cases via the median aperture approach, 7 cases via the median aperture-cerebellar vermis approach, and 9 cases via the transcerebellomedullary fissure approach. There were 17 cases with complete delivery of vesicles, 5 cases with vesicle rupture and 2 cases with extraction of cystic fluid followed by separation and removal of cystic wall. All cases had obvious retraction of the ventricular system and disappearance of intracranial hypertension following surgery. There were 19 cases (79.17%) with well recovery, and 5 cases (20.83%) with aggravation or development of cerebellar ataxia, which recovered following treatment for 1 to 2 weeks. Conclusion The transcerebellomedullary fissure approach is a safe and lowly invasive approach for the treatment of cysticercosis of the fourth ventricle.
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Objective To investigate the changes of brain CT imaging in patients with cerebral cysticercosis during the period of anti-cysticercus chemotherapy. Methods A total of 380 inpatients that were conformed to the practical diagnostic criteria of cerebral cysticercosis were enrolled in this study in the Third Affiliated Hospital of Shandong Academy of Medical Sciences from May 2010 to May 2015. All the patients were given anti-cysticercus chemotherapy (albendazole and praziquantel). All the patients received brain CT scan, and of which 210 received enhanced scan. The data of CT imaging were systematically reviewed. Results Before the treatment, the CT images of the patients showed single or multiple small cystic (s) with low density and small nodule-like cephalomere with high density. The re-examinations of CT showed that there were 81.58% (310/380) of the patients whose low density foci were completely absorbed, there were 16.32% (62/380) of the patients whose foci were mostly absorbed, and there were 2.11% (8/380) of the patients whose foci were calcified. Along with the prolongation of treatment time, the side effects were gradually reduced, and in the third course of treatment, the foci were absorbed or calcified in most of the patients. Conclusion CT examination can diagnose the lesion site, range and classification of cerebral cysticercosis, and can evaluate the effect of the therapy according to the changes of CT imaging during the period of anti-cysticercus chemotherapy.
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Objective To investigate the changes of brain CT imaging in patients with cerebral cysticercosis during the period of anti-cysticercus chemotherapy. Methods A total of 380 inpatients that were conformed to the practical diagnostic criteria of cerebral cysticercosis were enrolled in this study in the Third Affiliated Hospital of Shandong Academy of Medical Sciences from May 2010 to May 2015. All the patients were given anti-cysticercus chemotherapy (albendazole and praziquantel). All the patients received brain CT scan, and of which 210 received enhanced scan. The data of CT imaging were systematically reviewed. Results Before the treatment, the CT images of the patients showed single or multiple small cystic (s) with low density and small nodule-like cephalomere with high density. The re-examinations of CT showed that there were 81.58% (310/380) of the patients whose low density foci were completely absorbed, there were 16.32% (62/380) of the patients whose foci were mostly absorbed, and there were 2.11% (8/380) of the patients whose foci were calcified. Along with the prolongation of treatment time, the side effects were gradually reduced, and in the third course of treatment, the foci were absorbed or calcified in most of the patients. Conclusion CT examination can diagnose the lesion site, range and classification of cerebral cysticercosis, and can evaluate the effect of the therapy according to the changes of CT imaging during the period of anti-cysticercus chemotherapy.
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To analyze the characteristics of the results of serum immunological tests and brain CT image examinations of atypical cerebral cysticercosis patients, so as to provide the reference for improving the diagnosis of the disease.Totally 446 suspected cerebral cysticercosis patients were chosen as the study objects, all of them were given experimental treatment with praziquantel, and then the patients with atypical cerebral cysticercosis were diagnosed according to the treatment effect and review results of brain CT or MRI. Meanwhile, all the 446 patients were tested for serum specific IgG and IgG4 antibodies and cysticercus circulating antigen (CAg) by ELISA, McAb ELISA and PEG-ELISA respectively, and the IHA test was also performed. All the patients received the brain CT examinations. The test results were analyzed statistically and the test performances of the methods above-mentioned were calculated.Among the 446 suspected cerebral cysticercosis patients, after the praziquantel treatment, there were 315 patients whose symptoms were alleviated, and they were diagnosed as atypical cerebral cysticercosis. Among the 446 suspected cerebral cysticercosis patients, the positive rates of specific IgG and IgG4 antibodies, and CAg were 15.47%, 15.02%, and 11.21% respectively, and the positive rate of IHA was 28.47% (χ2 = 52.45, P ＜ 0.01). The brain CT examinations showed that there were 79.14% (353/446) of patients with suspected cysticercus foci. The sensitivities of ELISA, McAb-ELISA, PEG-ELISA, IHA test and brain CT examination (suspected cysticercus foci) for the diagnosis of atypical cerebral cysticercosis were 15.36%–96.82%, the specificities were 63.36%–99.24%, the positive predictive values were 86.40%–98.52%, the negative predictive values were 32.83%–98.25%, the positive likelihood ratios were 2.64–27.86, the negative likelihood ratios were 0.05–0.81, and the OR values were 7.16–52.80. The consolidation of the five tests above-mentioned showed the OR value was 108.00, which was 2 times of the OR value of CT examination.Atypical cerebral cysticercosis is definitely diagnosed mainly by means of evaluating the effect of the diagnostic therapy (anti-cysticercus), and the serum immunological examinations and brain CT examination also have important reference values.
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We explored the feature and therapeutic methods of cerebral cysticercosis.The effect of different surgical treatment was analyzed on 6 patients with cerebral cysticercosis who had undergone surgery at Fujian Provincial Hospital.Results showed that 2 of 6 cases underwent an excision of ventricle or cisternalcysticercus.Three cases were performed an excision of brain parenchyma cysticercus.The decompressivecraniectomy under bilateral temporalis was performed on 1 patient with cerebral cysticercosis.One case underwent ventriculo-peritoneal shunt because of hydrocephalus after a year of follow-up.The operations of 6 cases were all successfully performed.All patients recovered well after the operation.No newly neurobiological injuries were observed.Timely and accurate neurosurgery contributes to reduce the incidence of complications and cut down disability rate of cerebral cysticercosis,and buy time and fight for an opportunity for drug therapy of cerebral cysticercosis as well.It significantly improves the safety and therapeutic effect of anti-cysticercosis drugs.
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Objective To study the changes of cerebral function and pathological morphology before and after the antiparasit-ic treatment with albendazole and praziquantel in patients with cerebral cysticercosis. Methods The data of EEG and neuroimag-ing of 412 patients with cerebral cysticercosis were retrospectively analyzed. Results Before the treatment,the mild abnormali-ty,moderate abnormality,and severe abnormality were observed in 40.53%,45.63% and 13.84% of the patients respectively, which mainly showed the diffuse or focal irregular slow waves,or epileptiform discharges found in the abnormal brain waves. CT/MRI manifestation could be divided into six types,including single sacculus type(23.59%),multiple sacculus type(44.42%), encephalitis type(13.59%),coexistence of macrocyst and sacculus type(4.85%),calcification type(2.18%),and mixed type (11.41%). After 3 courses of the treatment,the normal and improved EEGs were observed in 79.85%and 20.15%,respectively. CT/MRI showed the foci being all absorbed(77.18%),being most absorbed(20.63%),and being no changes(20.18%)which were calcified focus. When cerebral cysticercosis were in acute stage(the single and multiple sacculus type,encephalitis type, and macrocyst and sacculus coexistence type),the therapeutic effect was good;while in the mixed type,the therapeutic effect was relatively poor. If cysticercosis were in the calcification stage,the patients only needed the heteropathy. Conclusions In the pa-tients with cerebral cysticercosis,EEGs show the mild to severe abnormalities,and CT/MRI mainly shows the multiple sacculus type. After the treatment,the abnormal EEGs are gradually recovered and the low density foci can be all absorbed,but some calci-fied focus still exist in some patients.
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Studty was conducted on 42 patients (32 males and 10 females, aged 14-55 years old) with taenia soluincyst in brain. The cyst was common at the age 20-49 years old, female 23.81% and male 76.19%. There was a diversity of nervous syndromes in both 2 hemispheres of brain, the most were intern-cerebral high pressure 95.2% and epilepsy 54.74%. Active forms of cyst accounted for 73.81%, needed for treating CT images of skull and brain showed a dispersion of the cyst in both 2 hemispheres of brain, consisted with the clinical symptoms.
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Cisticercosis/complicaciones , Taenia , EncéfaloRESUMEN
ObJective To measure the level of MDA and SOD in cerebrospinal fluid from patients with cysticercosis indifferent stages and to investigate their effects on this dieases. Methods Forty-nine patients with a single cysticercus incerebral parenchyma and twenty normal controls parlticipated in the study. According to the magnetic resonance imaging(MRI) results, patients were divided into four stages. The level of MDA,SOD in CSF were tested. The data were analyzedwith the software of SPSS. Results The amount of SOD was significantly decreased in all stages except the fourth stage,while the level of MDA was increased in all the stages,and reached its peak in the second stage. There was a negative cor-relation between SOD and MDA. Conclusion The data suggested oxygen free radicals may be a main mechanism of para-site killing.
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In 1996, the center for image diagnosis implemented CT scanner on 20 patients to identify cerebral cysticercosis. The results showed that the male/female patient rate was 4/1. The cysticercosis located mainly in brain, under skin and muscle. If cysticercosis found in brain, it should find cysticercosis whether is in the skin and muscle or not. And if the cysticercosis found in the skin and muscle and there is an intracranial hyperpressure, it should find the cysticercosis in the brain
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Neurocisticercosis , DiagnósticoRESUMEN
Objective To understand the effect of anti-cysticercus therapy for patients with cerebral cysticercosis and the changes of cysticercus on CT image after treatment. Methods The patients with cerebral cysticercosis were classified by the presentation of their brain CT image before treatment, then the effect of anti-cysticercus therapy on them after treatment was analyzed and the presentations of their brain CT images between before and after treatment were compared. Results There were different changes on CT image of cysticercus in brain tissues after anti-cysticercus therapy for different types of patients with cerebral cysticercosis. Type Ⅰ: the focus was absorbed completely after treatment in the majority of patients and calcificated in the minority. Almost all the patients were cured clinically after anticysticercus therapy. Type Ⅱ: the focus was absorbed completely in the minority, and one to two or more calcification dots were observed in the majority of patients. Anti-cysticercus therapy was effective. Type Ⅲ and Ⅳ: the absorption of focus was not very good and the effect of anti-cysticercus therapy was lower relatively. Conclusion The changes of CT image such as absorption, calcification, has important significance in forecasting prognosis and instructing clinical usage.
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Objective To detect the value of qualitative and orientating diagnosis in the degeneration stage of cerebral cysticercosis with Gd-DTPA enhanced MR. Methods Sixty-nine cases of cerebral cysticercosis were diagnosed by enhanced MR as degeneration stage, and confirmed by immunological examination and/or by surgery. MR plain scanning was conducted for the same cases. Results The plain scanning showed single or multiple lesions with long T1 and long T2 signals, and the enhanced scanning showed nodular or annular lesions. The diameter of the lesion after enhanced scan was not more than 22mm with an average value of 8.1mm. Some cases showed single lesion on plain scanning but showed multiple lesions after enhanced scan. Conclusion The enhanced MR shows more typical features of the degeneration stage cerebral cysticercosis. It can define the number, position and range of the lesions, and can improve the accuracy of differential diagnosis, and therefore be of importance in formulating treatment scheme and prognosis.
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The results of detection of circulating antigen(CAg) in cerebrospinal fluids(CSF) of 231 cerebral cysticercosis patients with McAb(4F8)-based ELISA were reported and compared with the case histories , clinical manifestations and CT scans. No relationship was found between CAg detected in CSF of these cases and history of taeniasis. However, the positive rate of CAg in cerebral cysticercosis patients with subcutaneous nodules was found significantly higher than those in cases with simple cerebral cysticercosis and in cases with subcutaneous nodules disappeared after anti-Cysticercus therapy before CSF collection. The results of CAg detection in CSF were related with the CT findings as well as the stage of the disease. It is thus indicated that MeAb(4F8)-based ELISA might be useful not only for diagnosis of neurocysticercosis, but also for the evaluation of efficacy of anti-Cysticercus therapy.
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Cerebral cysticercosis is unfortunately a not uncommon disease in Korea, which was a hardly manageable parasitic infestation on the central nervous system. After the introduction of the brain C-T scan, diagnosis and treatment of cerebral cysticercosis were improved markedly. The author analyzed 94 cases of cerebral cysticercosis who had been admitted to the Department of Neurosurgery and Neurology, Yonsei University Medical School from July 1972 to June 1983. Of the 94 patients, 52 operations were performed in 47 patients. The analysis and evaluation were made with particular emphasis on brain C-T scan finding.
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Humanos , Encéfalo , Sistema Nervioso Central , Cisticercosis , Diagnóstico , Corea (Geográfico) , Neurología , Neurocirugia , Facultades de MedicinaRESUMEN
We report a case of disseminated calcific cysticercosis of brain, accompanied with marked hydrocephalus. Histopathologically, the calcific spots consisted of mummified scolex and bladder of cysticercus cellulosae with a diffuse calcification, but no area of cystic change were noted. Surrounding brain tissue showed a dense fibrous reaction and gliosis with little foreign body reaction.