[Imaging characteristics of different types of cerebral cysticercosis].

OBJECTIVE: To study the imaging characteristics of different types of cerebral cysticercosis. METHODS: The CT and MRI findings of 166 patients with clinical diagnostic cerebral cysticercosis were reviewed retrospectively. RESULTS: Among the 166 cerebral cysticercosis patients, there were 108 cerebral parenchyma type cases, 15 ventricles type cases, 3 meningeal type cases, and 40 mixed type cases according to the cysticerci being in the parts of the brain. The CT and MRI imaging characteristics of various types were as the following. (1) Brain parenchyma type included the cystoid subtype, encephalitis subtype, nodular or multiple ring enhancement subtype, and chronic calcification subtype. The cystoid subtype: CT showed single or multiple cystic shadow (s) with clear boundary, and the sac with a high density of scolex; MRI showed round long T1 and long T2 signals, eccentric punctate shadows inside the sac, cystic wall and scolex signals, but no significant enhancement. The encephalitis subtype: CT showed scattered low density lesions and MRI showed patchy slightly long T1 and long T2 signals, but no enhancement or irregular enhancement in the majority. The nodular or multiple ring enhancement subtype: CT scan showed low density lesions in multiple nodules, or CT enhancement scan showed multiple nodules or ring enhancement. The chronic calcification subtype: CT showed single or multiple dot-like high density single (s), and MRI showed equal or long T I and short T2 signals. (2) Ventricular type: The lesions were often in the third and fourth ventricles complicated with obstructive hydrocephalus. (3) Meningeal type: there were expand and asymmetric cerebrospinal space limitations, communicating hydrocephalus, and the enhanced scan showed leptomeningeal enhancement. (4) Mixed type: The performance was mixed as two or more types above mentioned, and there existed mixed acute and chronic phases. CONCLUSIONS: The imaging findings of the different types of cerebral cysticercosis are differ from one another. The analysis of the imaging characteristics of the different types of cerebral cysticercosis has a significance for the clinical diagnosis, treatment and prognostic judgment of cerebral cysticercosis patients.

Increased expression of ICAM-1 among symptomatic neurocysticercosis.

Neurocysticercosis (NCC) is a common parasitic infection of the central nervous system (CNS) caused by larvae of Taenia solium. Most infected individuals remain asymptomatic while few develop symptoms i.e. seizures. Integrity or disruption of blood brain barrier plays an important role in CNS infection and inflammatory response. Therefore, we studied the induction of Th1 (TNF-alpha, IFN-gamma, IL-1beta and IL-2), Th2 (IL-4), IL-10 cytokines and adhesion molecule sICAM-1 in the lymphocytes isolated from symptomatic and asymptomatic NCC cases by stimulating them with Taenia solium cyst fluid antigens. The expression of TNF-alpha, IFN-gamma, IL-1beta and sICAM-1 was significantly higher only in symptomatic NCC cases. Our study highlights the role of adhesion molecules in the development of symptoms in NCC.

Serum and cerebrospinal fluid S100B concentrations in patients with neurocysticercosis

The clinical manifestations of neurocysticercosis (NC) are varied and depend on the number and location of cysts, as well as on the host immune response. Symptoms usually occur in NC when cysticerci enter a degenerative course associated with an inflammatory response. The expression of brain damage markers may be expected to increase during this phase. S100B is a calcium-binding protein produced and released predominantly by astrocytes that has been used as a marker of reactive gliosis and astrocytic death in many pathological conditions. The aim of the present study was to investigate the levels of S100B in patients in different phases of NC evolution. Cerebrospinal fluid and serum S100B concentrations were measured in 25 patients with NC: 14 patients with degenerative cysts (D), 8 patients with viable cysts (V) and 3 patients with inactive cysts. All NC patients, except 1, had five or less cysts. In most of them, symptoms had been present for at least 1 month before sample collection. Samples from 8 normal controls (C) were also assayed. The albumin quotient was used to estimate the blood-brain barrier permeability. There were no significant differences in serum (P = 0.5) or cerebrospinal fluid (P = 0.91) S100B levels among the V, D, and C groups. These findings suggest that parenchymal changes associated with a relatively small number of degenerating cysts probably have a negligible impact on glial tissue.

Neurocysticercosis: evaluation with advanced magnetic resonance techniques and atypical forms.

Neurocysticercosis (NCC) is the most common helminthic infection of the central nervous system, but its diagnosis remains difficult. The purpose of this article is to perform a critical analysis of the literature and show our experience in the evaluation of NCC. We discuss the advanced MR technique applications such as diffusion and perfusion-weighted imaging, spectroscopy, cisternography with FLAIR, and supplemental O2 and 3D-CISS. The typical manifestations of NCC are described; emphasis is given to the unusual presentations. The atypical forms of neurocysticercosis were divided into: intraventricular, subarachnoid, spinal, orbital, and intraparenchymatous. Special attention was also given to reactivation of previously calcified lesions and neurocysticercosis associated with mesial temporal sclerosis.

Diagnostico e tratamento da neurocisticercose / Diagnosis and treatment of neurocysticercosis

Objetivo: Estudo da neurocisticercose (NC) abrangendo o período 3 janeiro de 1980 a outubro de 2001 em pacientes atendidos nos hospitais Vera Cruz e Alberto Cavalcanti de Belo Horizonte - MG. Metodologia: foram estudados 398 pacientes, sendo que 318 apresentavam a forma inativa da doença e 80 a forma ativa. Em arte da casuística (32 pacientes) foi avaliado o efeito terapêutico a dexametazona associada a drogas parasiticidas sobre a forma ativa parenquimatosa da NC. Resultados: as manifestações clínicas mais frequentes foram a epilepsia (57,8%), hidrocefalia (11,0%) e hipertensão intracraniana (6,0%). Radiografia do crânio, tomografia computadorizada cerebral e ressonância magnética foram positivas para o diagnóstico da NC em 10,5%, 63,0% e 100,0% dos casos, respectivamente. Melhores resultados terapêuticos sobre a forma ativa parenquimatosa foram obtidos com a associação de corticosteróide com os parasiticidas. Conclusões: a classificação da NC em formas ativas e inativas é essencial para decidir a terapia. O tratamento com associação de corticosteróide e droga parasiticida mostrou-se mais eficaz para normas intra-parenquimatosas em relação ao uso exclusivo de corticostereóides. A NC não está erradicada em nosso meio.

The experience with 398 patients with neurocysticercosis during 20 years is reported. The inactive and active forms of the disease were diagnosed in 318 and 80 patients, respectively. The most frequent clinical manifestations were epilepsy (57.8%), hydrocephalus (11.6%) and intra-cranial hypertension (6.1%). Skull X-ray, cerebral computerized tomography, and magnetic resonance imaging were positive for the diagnosis of neurocysticercosis in 10.5%, 63.0% and 100% of the cases, respectively. In 32 patients with the active form of the disease the therapeutic effects of dexametasone alone (16 patients) and the combination of dexametasone and parasiticidal drugs (16 patients) were evaluated. Best therapeutic results were obtained with the combination of corticosteroids and parasiticidal drugs.

Ununsual manifestations of neurocysticercosis in MR imaging: analysis of 172 cases.

PURPOSE: The typical manifestations of neurocysticercosis are described widely in the literature. The purpose of this study is to demonstrate the uncommon presentations of different forms of neurocysticercosis in MR imaging. METHOD: A retrospective analysis of 172 cases of neurocysticercosis in MR studies was carried out over a period of 13 years. One hundred and four males and 68 females with a mean age of 32 3.7 years were studied. The studies were performed on 1.5 T GE MR units and T1 was used before and after gadolinium injection, T2 and gradient-echo (T2*) sequences. RESULTS: The authors divided the unusual manifestations of neurocysticercosis into: intraventricular, subarachnoid, spinal, orbital, intraparenchymatous, and reactivation of previously calcified lesions. The results obtained were: intraparenchymatous 95 cases (55.23%); intraventricular 27 cases (15.69%); subarachnoid 20 cases (11.63%); spinal 6 cases (3.49%); orbital 1 case (0.58%); reactivated lesion 1 case (0.58%); association of intraventricular and intraparenchymatous 12 cases (6.98%); association of subarachnoid and intraparenchymatous 6 cases (3.49%); association of subarachnoid and intraventricular, 4 cases (2.32%). CONCLUSION: MR imaging is a sensitive and specific method in the analysis of different forms of unusual manifestations of neurocysticercosis, which should appear in the differential diagnosis of parenchymal, ventricular, spinal, cisternal, and orbital lesions.

Manifestacioners radiológicas de la neurocistecercosis en los pacientes del hospital Escuela Antonio Lenin Fonseca febrero - diciembre deel 2004 / Radiological Manifestacioners of the neurocistecercosis in the patients of the hospital School Antonio Lenin Fonseca February - December deel 2004

Estudio descriptivo, transversal realizado en el servicio de Neurología del Hospital Escuela Antonio Lenin Fonseca, durante el período de febrero - diciembre del 2005, que incluyó a 69 pacientes con diagnóstico de Neurocisticercosis, con el objetivo de identificar las manifestaciones radiológicas de la enfermedad. La edad promedio fue el rango de 31- 40 años (27.54 por ciento), sin predominio por el sexo. El 56.5 por ciento de los pacientes procedian de áreas rurales. El tiempo de evolución de la neurocisticercosis en este estudio fue el comprendido entre 1 y 5 años, desde el inicio de la enfermedad y el diagnóstico. Las convulsiones fueron el hallazgo clínico más común (60.8 por ciento), seguido de la cefalea (24.6 por ciento). Se realizaron pruebas de diagnóstico auxiliares que incluyeron hemograma, coprológico, citoquímico del LCR y ELISA indirecto, cuyos resultados fueron de neurocisticercosis. El estudio de imagen con hallazgos sugerentes de neurocisticercosis fue 100 por ciento, La lesión más frecuente encontrada en este estudio fue el nódulo calcificado (80 por ciento), que corresponde al estadio evolutivo nodular calcificado (80 por ciento), siendo el parénquima cerebral el sitio de mayor afectación (94 por ciento). El 96 por ciento de los pacientes quedaron en la categoria diagnóstica de diagnóstico probable, cumpliendo con criterios ya establecidos...

The clinical spectrum of neurocysticercosis in the Uttaranchal region.

OBJECTIVES: To study the clinical and radiological spectrum of neurocysticercosis in the Uttaranchal region. METHODS: A total of 592 patients of neurocysticercosis attending various health camps, medical outdoor and indoor department were studied for their clinical and radiological presentation. RESULTS: Out of the total 15,000 patients screened, 592 patients (3.94%) were found to be suffering from neurocysticercosis. Majority of them were in the age group of 21-30 years. Most of them presented with generalized seizures (62.5%), others had headache (37.5%), focal seizures (20.8%), localizing neurological signs (16.6%), meningitis (4.1%), and dementia (1.3%). Radiologically, parenchymal lesions were most prevalent (81%). However, interventricular lesions were also not very uncommon (32%). Most of them had single lesions (53.5%), 26.7% had multiple lesions and 0.7% had midline shift. Significantly, large number of patients were vegetarians (39%); only 17.6% were pork eaters while the remaining 82.4% never had pork in their meals. CONCLUSION: We believe that such high percentage is at least a rough indicator of high incidence and prevalence of neurocysticercosis in the Uttaranchal region. They had wide range of clinical and radiological presentation. Small number of pork eaters and a significant number of vegetarians suggest other modes of transmission and needs further evaluation.