A proposal to declare neurocysticercosis an international reportable disease.

Neurocysticercosis is an infection of the nervous system caused by Taenia solium. It is the most important human parasitic neurological disease and a common cause of epilepsy in Africa, Asia, and Latin America, representing enormous costs for anticonvulsants, medical resources and lost production. Neurocysticercosis is a human-to-human infection, acquired by the faecal-enteric route from carriers of intestinal T. solium, most often in areas with deficient sanitation. Intestinal tapeworms cause few symptoms, but adult taeniae carried by humans release large numbers of infective eggs and are extremely contagious. Ingestion of poorly cooked pig meat infested with T. solium larvae results in intestinal taeniosis but not neurocysticercosis. With a view to hastening the control of taeniosis and neurocysticercosis we propose that neurocysticercosis be declared an international reportable disease. New cases of neurocysticercosis should be reported by physicians or hospital administrators to their health ministries. An epidemiological intervention could then be launched to interrupt the chain of transmission by: (1) searching for, treating and reporting the sources of contagion, i.e. human carriers of tapeworms; (2) identifying and treating other exposed contacts; (3) providing health education on parasite transmission and improvement of hygiene and sanitary conditions; and (4) enforcing meat inspection policies and limiting the animal reservoir by treatment of pigs. We believe that the first step required to solve the problem of neurocysticercosis is to implement appropriate surveillance mechanisms under the responsibility of ministries of health. Compulsory notification also has the major advantage of providing accurate quantification of the incidence and prevalence of neurocysticercosis at regional level, thus permitting the rational use of resources in eradication campaigns.

La esclerosis en placas en el Perú / Sclerotic plaques in Peru: a more common condition than it classically used to be?

Entre 1993 y 1998 hemos estudiado 91 casos de esclerosis en placas (EM). Su diagnóstico ha sido hecho siguiendo los criterios clínicos de Poser y los criterios de resonancia magnética de Paty, Asbury y Herndon. Todos ellos fueron estudiados por uno de los presentadores en el Instituto Nacional de Ciencias Neurológicas "J.O. Trelles" y en RESOMASA. La enfermedad predomina, como es clásico considerar, en el sexo femenino, comenzó en la mayoría de nuestros sujetos entre los 20 y los 40 años y la mayoría de las formas fueron del tipo remisión recaídas. Todos nuestros pacientes son de origen europeo o mayoritariamente europeo hasta donde es posible evaluar por el aspecto fenotípico y por sus apellidos. La mayoría proviene de la costa, sobre todo de Lima y alrededores. No hemos encontrado, hasta el momento, ningún paciente de origen amerindio. Concluimos que la esclerosis múltiple no es una enfermedad rara en el Perú como se creía clásicamente e invocamos a iniciar un estudio epidemiológico multicéntrico para determinar con certeza las características epidemiológicas de la enfermedad.

Neurocysticercosis and epilepsy in Peru.

This study was carried out to determine the prevailing type of epilepsy in neurocysticercosis. We also evaluated if it could account for the predominance of generalized epilepsy in Peru. We studied the records and EEGs of 49 cases of neurocysticercosis, representing 5.9% of all hospital admissions. Cysticercosis was diagnosed using clinical, blood, CSF (complement fixation, ELISA, immunoblot) and CT scan criteria. We found 49 epileptic patients. Their type of epilepsy was as follows: 35 subjects had generalized epilepsy and 14 had partial epilepsy (5 motor partial, 5 complex partial, both with secondary generalization and 4 motor partial). All but 3 patients were over 25 years old (mean 33 years). We conclude that generalized epilepsy is frequent among cysticercosis patients and that it may account, partially, for the predominance of generalized seizures in Peru and in other areas of South America where cysticercosis is endemic.

Spastic paraparesis and HTLV-I infection in Peru.

Three of 6 patients with spastic paraparesis in Lima, Peru, were found to have antibodies to human T-lymphotropic virus type I (HTLV-I). Blood and cerebrospinal fluid antibodies were confirmed by Western blot analysis. Multilobulated lymphocytes in blood and cerebrospinal fluid of the index case stained with monoclonal antibodies for T-helper cells and for T10, an activation marker. Blood mononuclear cells from patients with HTLV-I-associated myelopathy showed spontaneous proliferation in culture, evidence of interleukin-2 receptors, and decreased natural killer cell activity.

Decreased digitalis receptor activity in acute rejecting canine transplanted heart.

In the course of acute rejection, myocardial tissue undergoes massive transformation and we hypothetized that for digitalis-like substances, receptor binding characteristics might be altered. Ten canine heterotopic cardiac allografts were carried out and were harvested once rejection had developed (8-10 days post-transplant). Microsomal membrane fractions of those grafts and of native hearts were isolated. Radioligand binding studies were carried out in a medium containing 5 mM Tris PO4, 50 mM Tris HCl, 5 mM MgCl2, pH 7.4 at 37 degrees C, using 3H-ouabain as the ligand. Saturation experiments (n = 10) indicate the presence of one homogeneous population of high affinity binding sites with an affinity constant (Kd) of 8-13 nM and a maximum binding capacity (Bmax) of 47 +/- 3.5 pmol/mg protein. Both saturation and competition binding studies illustrate the fact that acute rejection resulted in a significant decrease in Bmax (43%) without significant alteration in Kd value. These studies indicate that digitalis-like substances might not exert significant inotropic activity during rejection, but this hypothesis must be confirmed by in vivo haemodynamic experiments.

[Disappearance of tardive dyskinesia in a manic attack]. / Disparition de dyskinésies tardives au cours d'un accès maniaque.

A 66 year-old man suffered of a manic-depressive illness. Tardive dyskinesia appeared after a treatment with chlorpromazine. Abnormal movements were present at normal and depressive states, but disappeared during manic phases. A few similar cases have been reported. The authors suggest that a modification in the sensibility of monoaminergic receptors could explain the disappearance of dyskinetic movements during mania.

[Human peripheral neurolymphomatosis]. / La neurolymphomatose périphérique humaine.

Two further cases of human neurolymphomatosis are reported, and clinical, histopathologic and nosologic features of the affection reviewed with respect to findings in these 2 patients and in 7 other reported cases. Clinical manifestations are those of a flaccid ascending paralysis, associated in most cases with an asymmetrical abolition of tendon reflexes, violent muscular pains and sphincter disturbances, frequently preceded by a regressive cranial nerve palsy. Pathology shows infiltration of the peripheral nervous system (nerves, roots, and spinal ganglia) by lymphoid cells, sometimes associated with central nervous system (cord and brain) infiltrates in severe advanced cases. Involved nerves are increased in size. The disease could be a viral polyradiculoneuritis due to the virus of Marek's disease. Arguments in favor of this hypothesis include: the onset of the affection in subjects working in poultry farms under poor hygienic condition; the fact that clinical and histologic findings are similar to those in Marek's disease and the failure, after careful examination, to detect any malignant blood disorder or lymphoma in one of the cases studied.

[Human peripheral neurolymphomatosis (reticuloendothelial polyradiculoneuritis)]. / Neurolymphomatose périphérique humaine (polyradiculonévrite réticuloendothéliosique)

This is the clinico-pathological report of a case of reticulo-endotheliosis of the nervous system in a 53-year-old white female. She had a history of transient facial palsy followed 6 months later by progressive weakness, paresthesiae and severe pain in both lower limbs. Clinical examination revealed signs of sensory and motor polyradiculoneuritis with involvement of the oculomotor, facial and trigeminal cranial nerves. She died 10 months after the onset because of bronchopneumonia. Pathological findings in the nervous system were limited to the cranial and spinal roots and ganglia. Histopathological examination showed intense infiltration by lymphocytes, histiocytes, plasmocytes and macrophages and a large amount of reticulin. The left oculomotor nerve, both Gasserian ganglia, the right trigeminal nerve and the lumbosacral nerves and ganglia were particularly involved. The previous literature on human peripheral neurolymphomatosis is reviewed and its differential diagnosis from Marek's disease, sarcomas, leukaemic polyradiculoneuritis, sarcoidosis and Hodgkin's disease of the nervous system is discussed. The importance of recognizing this variety of polyradiculoneuritis, and methods of treating it are emphasized.

Bulbar infarcts. Vascular lesions in 26 observations. / Les infarctus bulbaires. Etude des lésions vasculaires dans 26 observations.

The pattern of arterial occlusion and related lesions have been studied in 26 cases with 38 medullary infarcts. In 10 of these cases, only the intracranial vessels were examined. In the 16 other cases, the entire cerebral arterial supply was dissected. Medial infarcts were more often related to occlusion of the vertebral artery involving the termination of the artery (7/10 cases). In 6 cases a thrombosis on an atheromatous plaque and, once, an embolus of cardiac origin, were found. Lateral infarcts were usually due either to occlusion of the vertebral artery (14/23 cases), reaching, in 10 cases, the mouth of the posterior inferior cerebellar artery (PICA) or to an isolated occlusion of the latter vessel (3 cases). A thrombosis on an atheromatous plaque was found in 15 cases, and emboli from the heart or from the origin of the vertebral artery in the others. The dorsal infarcts were related, in 4/5 cases, to an isolated occlusion of the stem of the PICA and, in the other case, to one of the vertebral artery involving the ostium of the PICA. A thrombosis due to atheromatous stenosis was found in 4 cases, an embolus of cardiac origin in the other one.

Bulbar infarcts. Systematic study of lesion topography in 49 cases. / Les infarctus bulbaires. Etude systématique de la topographie lésionnelle dans 49 cas.

A pathological study has been carried out of 49 examples of medullary infarction in 33 patients. The medial infarcts, very seldom single (2 /12), spared the subolivary levels. The pontomedullary junction was affected in 3 /9 cases studied. The lesions were more frequent in the ventral part of the arterial zonal pattern. They more often extended to its dorsal part at the level of the middle and upper one-third of the olive. The lateral infarcts, seldom single (6/30), extended to the subolivary levels in 6/22 cases studied and to the pontomedullary junction in 9/24 cases. The structures involved in each case and the area of the lesions at each cranio-caudal level have been studied. None of the 7 dorsal infarcts was single; in 6 of these cases there was also a cerebellar infarct involving the area of supply of the posterior inferior cerebellar artery. The subolivary levels (1/6) and ponto-medullary junctions (1/6) were seldom affected. The extent of the lesions in these uncommon infarcts has been described in detail.