Comparative Study of Paired Serum and Cerebrospinal Fluid Samples from Neurocysticercosis Patients for the Detection of Specific Antibody to Taenia solium Immunodiagnostic Antigen.

Neurocysticercosis (NCC) is an important disease of the central nervous system caused by infection with Taenia solium metacestodes. In addition to the clinical findings and the imaging analysis, the results of immunological tests are informative for the diagnosis of NCC. To compare the usefulness of serum and cerebrospinal fluid (CSF) samples for antibody detection, paired serum and CSF samples from patients with NCC and other neurological diseases were examined by an enzyme-linked immunosorbent assay with low-molecular-weight antigens purified from T. solium cyst fluid in a blinded fashion. The sensitivity of both serum and CSF samples was 25.0% in inactive NCC cases (n = 4) and 90.9% in active NCC cases (n = 33), and the specificity of serum and CSF was 100% and 95.8%, respectively. When the serum and CSF samples were combined, the sensitivity in active NCC cases became 100%. There was no difference in test performance between serum and CSF samples. Based on these results, we recommend the detection of specific antibodies in serum for the diagnosis of active NCC because of the ease of collection. When the antibody test is negative, however, CSF should be used to confirm NCC and to rule out other medical disorders of the central nervous system. Antibody detection test using only serum or CSF has a limited diagnostic value and cannot be recommended for the diagnosis of suspected inactive NCC cases.

Neurocysticercosis: clinical manifestation, neuroimaging, serology and molecular confirmation of histopathologic specimens.

Diagnosis of neurocysticercosis (NCC) is usually based on neuroimaging and/or immunological analysis of cerebrospinal fluid (CSF) and/or serum samples for detection of specific antibodies against T. solium antigens. Additional confirmative diagnosis may be possible by morphological and molecular confirmation of resected histopathologic specimens. The majority of NCC cases do not always show typical neuroimaging figures with invaginated scolex. So, serology using highly specific antigens of T. solium, either semi-purified native or recombinant antigens, is essential for confirming NCC cases. There is some debate about the usefulness of CSF and serum for immunodiagnosis. When NCC cases with a solitary cyst or with calcified lesions are examined, serology is not always sensitive to differentiating such cases. Malignant brain tumor is most commonly suspected in Japan and is often treated surgically as an urgent task, if the clinicians have no experience of NCC cases. Only histopathological specimens are expected to show direct evidence of T. solium cysticercosis. Morphology is not always sufficient for identification of the Taenia species, even if the majority of cysticerci in the human brain are expected to be T. solium. Crucial confirmation is based on molecular identification. In this review, these four issues are briefly summarized.

Notificaçäo compulsória da cisticercose em Ribeiräo Preto - SP / Compulsory notification of cysticercosis in Ribeiräo Preto - SP

A cisticercose é grave problema de saúde pública em várias regioes da Asia, Africa e América Latina. Os estudos epidemiológicos baseados na frequência de casos nos serviços especializadas de neurologia, neurocirurgia, tomografia computadorizada, nas necrópsias e nos estudos soroepidemiológicos nao permitem a avaliaçao da real prevalência populacional. O presente estudo teve como objetivo a análise da prevalência da cisticercose no município de Ribeirao Preto, através da notificaçao compulsória implantada em caráter pioneiro no Brasil. O coeficiente de prevalência foi de 54 casos/lOOOOO habitantes, no período de 2O-outubro-l992 a 31-de-dezembro de 1995. Os resultados indicaram, adicionalmente, que a cisticercose nao está sob controle no nosso meio pois 21 por cento dos casos notificados apresentavam a forma ativa. A notificaçao compulsória revelou ser recurso valioso para o estudo epidemiológico da cisticercose, permitindo, adicionalmente, o mapeamento das áreas mais afetadas para melhor direcionamento das estratégias de prevençao.

Crises parciais motoras induzidas por movimentos em pacientes diabéticos / Partial motor seizures induced by movement in diabetic patient

Levando em conta o número restrito de casos em âmbito internacional e a ausência de publicaçöes na literatura nacional, os autores apresentam três casos de crises motoras focais induzidas por movimentos em pacientes diabéticos com mais de 50 anos de idade. As crises eram numerosas, sendo também desencadeadas ao serem assumidas determinadas posturas. Em dois casos havia hiperglicemia näo cetótica. Todos os pacientes apresentavam hemiparesia, em dois, tal deficit desapareceu após o controle das crises. No outro paciente a hemiparesia era decorrente de acidente vascular cerebral isquêmico instalado 6 meses antes. Síndrome parietal transitória foi observada nos três pacientes. O EEG crítico mostrou, em dois pacientes, descargas na regiäo parieto-occipital e, em um, na regiäo temporal média contralateral. As crises foram resistentes aos anticonvulsivantes, só havendo controle com o tratamento dos distúrbios metabólicos. Säo discutidos aspectos clínico-eletrencefalográficos e etiopatogênicos. A pesquisa do caráter reflexo das crises e a dosagem da glicemia devem ser feitas em todos os pacientes idosos com crises motoras focais, face às implicaçöes ...