Características clínicas de la neurocisticercosis en un hospital referencial del norte del Perú. 2016-2018 / Clinical characteristics of neurocysticercosis from a reference hospital of the northern of Peru. 2016-2018

INTRODUCCIÓN: La neurocisticercosis (NCC) es la parasitosis más común del sistema nervioso central, siendo una causa muy importante de epilepsia. OBJETIVO: Describir las características de pacientes con NCC atendidos en un hospital de alta complejidad de Lambayeque durante el período 2016-2018. PACIENTES Y MÉTODOS: Se revisaron las historias clínicas de pacientes con diagnóstico de NCC y se recolectó su información en una ficha de datos. RESULTADOS: 46 historias cumplieron criterios de inclusión; 23 correspondían a varones, la mediana de edad fue 46,5 años (RIC: 26,5-63), el paciente más joven tuvo 7 años, el más longevo 85 años; 30 procedían de la región Lambayeque. Epilepsia se presentó en 24 pacientes, hipertensión endocraneal en 10, síndrome psíquico en dos, déficit neurológico focal en 1, síndrome visual en 1, un paciente fue asintomático. Siete pacientes tuvieron epilepsia y otro síndrome simultáneamente. En las neuroimágenes, las calcificaciones cerebrales fueron las lesiones más comunes; 9 tuvieron quistes sub-aracnoideos. En 20 pacientes se efectuó serología por western blot, siendo positiva en 11; 38 fueron clasificados como NCC definitiva y 8 probable. Recibieron solamente tratamiento sintomático18 pacientes, 27 tratamiento antiparasitario y 6 adicionalmente tratamiento neuroquirúrgico. Falleció un paciente. CONCLUSIONES: La sintomatología y los hallazgos de neuroimágenes fueron proteiformes y la mortalidad fue baja.

BACKGROUND: Neurocysticercosis (NCC) is the most common parasitosis of the central nervous system, and a very important cause of epilepsy. AIM: To describe the clinical features of patients with NCC attending a high level hospital from Lambayeque during: 2016-2018. METHODS: The medical records of patients with NCC were reviewed, and their information was collected on a data sheet. RESULTS: 46 stories met the inclusion criteria; 23 patients were male, the median age was 46.5 years (IQR: 26.5-63), the youngest patient was 7 years old, and the longest 85. Thirty patients were from Lambayeque. Epilepsy occurred in 24 patients, intracranial hypertension in 10, psychic syndrome in 2 and focal neurological deficit and visual syndrome in 1; there was one asymptomatic patient and seven had epilepsy and another syndrome. In neuroimaging, cerebral calcifications were the most common lesions; 9 patients had subarachnoid cysts. Serology (western blot) was performed in 20 patients being positive in 11; 38 were definitive NCC and 8 probable. Eighteen patients received only symptomatic treatment, 27 antiparasitic treatment and 6, additionally neurosurgical treatment. Only one patient died. CONCLUSIONS: The symptoms and neuroimaging findings were proteiform and the mortality found was low.

Bruns Syndrome Caused by Intraventricular Neurocysticercosis: Literature Review

Bruns syndrome is one of the clinical presentations of intraventricular neurocysticercosis, and it is characterized by episodes of headache, vertigo and vomiting. The intraventricular form of neurocysticercosis occurs in 7% to 20% of the cases, and it is more serious than the intraparenchymal form. The management is primarily surgical, associated with pharmacological therapy with anthelmintic drugs and corticosteroids. We report the case of a patient who presented Bruns syndrome due to neurocysticercosis.

Descripción clínico-radiológica de un angiosarcoma cardiaco con metástasis cerebral que simula un quiste hidatídico / A radiological and clinical description of metastatic angiosarcoma simulating a hydatid cyst

RESUMEN Los angiosarcomas son sarcomas malignos que se originan en las células endoteliales vasculares. Su diagnóstico diferencial es muy amplio debido a su parecido con otras enfermedades, como las parasitarias, y usualmente es un diagnóstico por exclusión. La neurocisticercosis y la hidatidosis cerebral son parasitosis intestinales que pueden comprometer el sistema nervioso central y tienen mayor incidencia en los países suramericanos. El diagnóstico se establece a partir del perfil epidemiológico, el estudio parasitológico, la apariencia radiológica de las lesiones y el estudio de histopatología del espécimen. Se presenta el caso de una adolescente con factores de riesgo para parasitosis y neuroimágenes sugestivas de hidatidosis cerebral, cuyo diagnóstico definitivo fue angiosarcoma cardiaco metastásico.

ABSTRACT Angiosarcoma is the most malignant sarcoma originating in endothelial vascular cells. It has a wide differential diagnosis due to its similarities with other entities, such as parasitic diseases. More often, angiosarcoma is diagnosed by exclusion. Neurocysticercosis and hydatid disease, or echinococcosis, are parasitic infections that may involve the central nervous system and their incidence is higher in South American countries. Diagnosis is established based on the epidemiological profile, the parasitological examination, the radiological appearance of the lesions, and the histopathology analysis of specimens. We present the case of a female adolescent with parasitosis risk factors whose neuroimages suggested cerebral hydatid cysts and who was finally diagnosed with cardiac metastatic angiosarcoma.

Subcutaneous nodules of cysticercosis as a sign of asymptomatic neurocysticercosis in an HIV positive patient

Abstract Cysticercosis is caused by the hematogenous dissemination of the larval form (cysticercus) of Taenia solium. It can affect any organ or tissue in the body but commonly affects the subcutaneous tissue, central nervous system, eyes, and skeletal muscle. Skin lesions can assist as a marker in the diagnosis of asymptomatic neurocysticercosis in endemic areas. A 49-year-old HIV positive man presented with multiple cutaneous nodules confirmed as cysticercomas which led to the diagnosis of asymptomatic neurocysticercosis. He was successfully treated with albendazole and steroids at recommended doses with no adverse effects.

Clinical, pathological and molecular evaluations and CT scan screening of coenurosis (Coenurus cerebralis) in sheep and calves / Avaliação clínica, patológica e molecular e tomografia computadorizada de cenurose (Coenurus cerebralis) em carneiros e bezerros

Abstract The aims of this study were to diagnose coenurosis by means of computerized tomography (CT) scan imaging and molecular characterization of the CO1 gene using the polymerase chain reaction (PCR). Sheep and calves were necropsied, and CT scans on the cephalic region were performed on the animals. Sections of brain tissue infected with parasites were then stained with hematoxylin and eosin for microscopic examination. Material collected from brain cysts was fixed in 70% ethanol. PCR amplification was carried out using the CO1 mitochondrial gene. A total of 60 calves and 80 sheep were examined clinically and, of these, 15 calves and 38 sheep showed signs of depression, with counterclockwise circling movements and altered head carriage. Four sheep and one calf were necropsied, and C. cerebralis cysts were detected in all of them. A hypodense cyst was monitored in the right cerebellar hemisphere on a CT scan on one sheep. A cyst was found in the left frontal lobe on a CT scan on one calf. Microscopically, C. cerebralis cysts were surrounded by a fibrous or epithelial wall that presented necrosis on cerebral sections of both the sheep and the cattle. The CO1-PCR assay yielded a 446 bp band, which was sequenced and phylogenetically analyzed: the results confirmed the presence of T. multiceps. This study reports the first use of CT imaging on naturally infected calves and sheep for diagnosing coenurosis.

Resumo Os objetivos deste estudo foram diagnosticar cenurose por tomografia computadorizada (CT) por imagem de digitalização e caracterização molecular do gene CO1, usando a Reação em Cadeia da Polimerase (PCR). Ovelhas e bezerros foram necropsiados, e uma tomografia computadorizada da região cefálica foi realizada nos animais. Em seguida, cortes microscópicos de cérebro infectado com parasitas foram corados com hematoxilina e eosina e posterior avaliação ao microscópio de luz. Em seguida, o material recolhido de cada cisto cerebral foi fixado em etanol a 70%. A amplificação pela PCR foi realizada utilizando-se o gene mitocondrial CO1. Um total de 60 bezerros e 80 ovelhas foram clinicamente examinados e, desses, 15 bezerros e 38 ovelhas apresentaram sinais de depressão, com movimentos circulares em sentido anti-horário, e desvio da cabeça. Quatro carneiros e uma vitela foram necropsiados, e cistos de C. cerebralis foram detectados nos animais. Um cisto hipodenso foi monitorado no hemisfério cerebelar direito por imagem do CT de um carneiro. O cisto foi encontrado no lobo frontal esquerdo por imagem do CT de um bezerro. Microscopicamente, cistos de C. cerebralis foram envolvidos por uma parede fibrosa ou epitelial, apresentando necrose em ambos os cortes cerebrais de ovinos e de bovinos. O ensaio CO1-PCR produziu uma banda de 446 pb, sequenciado e submetido à filogenia, confirmou ser T. multiceps. Este estudo relata a primeira utilização de imagens de CT em bezerros e ovelhas naturalmente infectados para o diagnóstico de coenurosis.

Neurocisticercosis racemosa del Valle Silviano con aneurisma inflamatorio de la arteria cerebral media derecha / Racemose neurocysticercosis of the Silviano Valley with inflammatory aneurysm of the right middle cerebral artery: case report

La neurocisticercosis (NCC) es la parasitosis más común del cerebro y presenta gran variedad de patrones pudiendo mimetizarse con numerosas patologías. Presentamos el caso de un paciente con aneurisma inflamatorio, del cual sólo encontramos 5 casos reportados en la literatura, y sólo uno cuenta con reporte histopatológico. El presente caso reporta un paciente con antecedente de diabetes mellitus e hipertensión arterial, que inició su padecimiento con crisis parciales simples secundariamente generalizadas.Al estudiar el paciente se le diagnosticó neurocisticercosis racemosa, se realizó resección de lesiones con ruptura transoperatoria de aneurisma inflamatorio secundario a NCC con clipaje exitoso. En la literatura se describen cambios inflamatorios en la pared del aneurisma y de la arteria dependiente, secundarios al proceso inmune con vasculitis asociada a un proceso inflamatorio crónico, estos cambios en la pared del aneurisma incrementa la posibilidad de rotura intraoperatoria. El reporte histopatológico fue concluyente con neurocisticercosis.

Neurocysticercosis (NCC) is themost common parasitic disease of the brain, has awide variety of patterns of presentation and can mimic many diseases. We report a patient with inflammatory aneurysm, and found only 5 cases reported in the literature, and only one has histopathological report.This is a case report of a patient with diabetes and arterial hypertension condition which started with simple secondary generalized partial seizures. The study reported the patient was diagnosed with neurocysticercosis racemosa, resection of lesions was performed with secondary inflammatory rupture intraoperative aneurysm clipping successful NCC,inflammatory changes in the literature described in the aneurysm wall and the dependent artery,secondary to immune process with vasculitis associated with a chronic inflammatory process, these changes in the aneurysm wall increase the possibility of intraoperative rupture. Histopathological report was conclusive with neurocysticercosis.

Neurocisticercosis racemosa subaracnoidea gigante y ventricular: a propósito de un caso / Giant racemose subarachnoid and intraventricular neurocysticercosis: A case report

La neurocisticercosis es la enfermedad parasitaria más frecuente del sistema nervioso central. Es causada por las larvas de Taenia solium, las cuales pueden estar alojadas en distintas localizaciones anatómicas. En países como España existe una prevalencia en ascenso debido, principalmente, a la inmigración desde regiones endémicas. Las formas extraparenquimatosas son menos frecuentes, pero más graves por su tendencia a producir complicaciones. La neuroimagen desempeña un papel primordial en el diagnóstico y seguimiento de esta enfermedad, apoyada en la serología y un contexto clínico-epidemiológico compatible. El tratamiento de elección son los fármacos cisticidas albendazol y praziquantel, habitualmente se asocian a estos corticoides y, cuando corresponde, la cirugía. Se presenta un caso de neurocisticercosis con afectación simultánea intraventricular y subaracnoidea en su forma racemosa gigante.

Neurocysticercosis is the most frequent parasitic disease of the central nervous system. It is caused by the larvae of Taenia solium, which can affect different anatomical sites. In Spain there is an increasing prevalence mainly due to immigration from endemic areas. The extraparenchymal forms are less common, but more serious because they usually develop complications. Neuroimaging plays a major role in the diagnosis and follow-up of this disease, supported by serology and a compatible clinical and epidemiological context. First-line treatments are cysticidal drugs such as albendazole and praziquantel, usually coadministered with corticosteroids, and in some cases surgery is indicated. We here report a case of neurocysticercosis with simultaneous intraventricular and giant racemose subarachnoid involvement.

Neurocysticercosis in children.

Neurocysticercosis (NCC) is a common cause of seizures and neurologic disease. Although there may be variable presentations depending on the stage and location of cysts in the nervous system, most children (> 80%) present with seizures particularly partial seizures. About a third of cases have headache and vomiting. Diagnosis is made by either CT or MRI. Single enhancing lesions are the commonest visualization of a scolex confirms the diagnosis. Some cases have multiple cysts with a characterstic starry-sky appearance. Management involves use of anticonvulsants for seizures and steroids for cerebral edema. The use of cysticidal therapy continues to be debated. Controlled studies have shown that cysticidal therapy helps in increased and faster resolution of CT lesions. Improvement in long - term seizure control has not yet been proven. Children with single lesions have a good outcome and seizure recurrence rate is low. Children with multiple lesions have recurrent seizures. Extraparenchymal NCC has a guarded prognosis but it is rare in children. In endemic areas NCC must be considered in the differential diagnosis of seizures and various other neurological disorders.

Reappearing CT lesions: 4 cases.

An overwhelming majority of disappearing CT lesions in India have been aetiologically linked to cysticercosis. We report 4 patients with disappearing CT lesions in whom the lesion later reappeared at the same (3 patients) or different site (1 patient). One patient was a Taenia carrier. Serial MRI evaluation in one patient revealed a persisting lesion in the interval period. The contribution of these observations towards the understanding of the aetiology of disappearing CT lesions is discussed.