ABSTRACT
BACKGROUND: Infection with the larval form of the pork tapeworm, Taenia solium, can lead to the development of cysts in the brain. Surgical removal of cysts has been the accepted treatment for neurocysticercosis characterized by giant cysts when there is associated intracranial hypertension. METHODS: We describe 33 patients whom we treated medically for malignant forms of neurocysticercosis. All patients had evidence of intracranial hypertension and subarachnoid cysts at least 50 mm in diameter. All patients received 15 mg of albendazole per kilogram of body weight per day for four weeks. Ten patients were also treated with 100 mg of praziquantel per kilogram per day for four weeks. Seventeen patients received a second course of albendazole, three received a third course, and one received a fourth course. During the first cycle of treatment, all patients also received dexamethasone. Five patients had previously undergone neurosurgery for giant cysts. RESULTS: After a median of 59 months of follow-up (range, 7 to 102), the condition of all 33 patients had improved, and the cysts had disappeared or become calcified. Of the 22 patients with a history of seizures, only 11 continued to receive antiseizure medications. The median quality-of-life score on the Karnofsky scale improved from 40 to 100. Fifteen patients received a ventriculoperitoneal shunt because of hydrocephalus. Four patients had persistent sequelae (bilateral partial optic atrophy, stroke, or diplopia) of the cysts. CONCLUSIONS: Intensive medical treatment can be effective in patients with neurocysticercosis characterized by giant cysts. Neurosurgery may be required only when there is an imminent risk of death.
Subject(s)
Albendazole/therapeutic use , Anticestodal Agents/therapeutic use , Brain Diseases/drug therapy , Neurocysticercosis/drug therapy , Praziquantel/therapeutic use , Adolescent , Adult , Aged , Aged, 80 and over , Albendazole/adverse effects , Anticestodal Agents/adverse effects , Brain Diseases/complications , Brain Diseases/diagnosis , Brain Diseases/surgery , Dexamethasone/therapeutic use , Drug Therapy, Combination , Female , Follow-Up Studies , Glucocorticoids/therapeutic use , Headache/chemically induced , Humans , Intracranial Hypertension/drug therapy , Intracranial Hypertension/etiology , Magnetic Resonance Imaging , Male , Middle Aged , Neurocysticercosis/complications , Neurocysticercosis/diagnosis , Neurocysticercosis/surgery , Praziquantel/adverse effects , Tomography, X-Ray Computed , Ventriculoperitoneal ShuntABSTRACT
Prospective study performed at the General Hospital, National Medical Center, XXI Century, Endocrinology Ward, Mexico-City, to compare the diagnostic sensitivity in Cushing's disease of the oral high doses (8 mg) dexametazone suppression test in single doses with nocturnal administration (DXM-N) and the classic doses of two days (DXM-C). Fourteen patients with hypercortisolism were studied; on thirteen the hypophyseal origin was surgical confirmed. Sensitivity of high doses of oral dexametazone test was proved by using serial samples of serum cortisol; the Fisher test was used for analysis of the suppression of serum cortisol after the test was done.
