Comparison of cellular responses in single- and multiple-lesion neurocysticercosis

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 characteristic 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.

Aspectos clínicos e evolutivos da hidrocefalia na neurocisticercose

Com o propósito de analisar os aspectos clínicos da hidrocefalia (HDC) na neurocisticercose (NCC), realizou-se o estudo retrospectivo de 47 prontuários de pacientes com HDC e NCC. Verificou-se que 70,2% eram homens, entre 21 e 50 anos. A hipertensão intracraniana (HIC) ocorreu em todos os pacientes, cefaléia (CEF) em 89,4%, meningoencefalite (ME) em 80,8% e distúrbios psíquicos (PSI) em 74,5%. A síndrome liquórica da NCC foi detectada em 65,9% pacientes. Além da HDC, as tomografias computadorizadas de crânio (TC) mostraram lesões císticas e edema cerebral difuso em 59,6% cada, calcificações em 55,3%. Dos 41 pacientes (87,2%) com derivação ventriculoperitoneal (DVP), em 22 (53,7%) deles foram necessárias uma a sete revisões/paciente (média=3). A evolução foi satisfatória em 51,1% e fatal em 31,9%. Conclui-se que a hidrocefalia é mais comum no sexo masculino em idade produtiva, tendo a HIC, CEF, MN e PSI como manifestações freqüentes e que, a necessidade de revisões de DVP, piora o prognóstico.

Neurocysticercosis in children

Neurocysticercosis is a major cause of neurologic disease worldwide. The clinical presentations are pleomorphic depending on the stage and location of cysts in the nervous system. Most children (> 80%) present with seizures, particularly partial seizures; headache and vomiting are seen in about a third of cases. Diagnosis is made by either computed tomography (CT) or magnetic resonance imaging. Single enhancing lesions are the most common finding. Visualization of a scolex confirms the diagnosis. Some cases have multiple cysts; the "starry-sky" appearance in cases with innumerable cysts is characteristic. Most children require anticonvulsants. Corticosteroids are indicated in those with cerebral edema. The efficacy of cysticidal therapy continues to be debated. Controlled studies suggest that cysticidal therapy helps in increased and faster resolution of CT lesions, but there is no conclusive evidence that it improves long-term seizure control. The prognosis in cases with single lesions is good; seizure control is achieved with a single anticonvulsant, and the recurrence rate is low. Children with multiple lesions have recurrent seizures. Extraparenchymal neurocysticercosis is rare in children and carries a poor prognosis. Neurocysticercosis must be considered in the differential diagnosis of seizures and a wide variety of neurologic disorders, particularly in endemic areas.