Neurocysticercosis

Transventricular endoscopic approach to the anterior interhemispheric fissure for neurocysticercosis: illustrative cases

BACKGROUND

Neurocysticercosis (NCC) is a global public health problem. It is a complex disease to manage and a cause of great morbidity and mortality in affected patients. Conventional surgical approaches have been used for many years, but currently, minimally invasive approaches are being used with good results. The authors present a case of NCC in the anterior interhemispheric fissure that was treated with a transventricular endoscopic approach.

OBSERVATIONS

A 32-year-old male patient was admitted for persistent moderate headache and dizziness. Gadolinium-enhanced magnetic resonance imaging (MRI) showed multiple parenchymal, ventricular, and subarachnoid cystic lesions, especially in the anterior interhemispheric space. A transventricular endoscopic approach was selected and applied. There were no complications during surgery. Pathological analysis confirmed the diagnosis of NCC. Control MRI demonstrated the absence of cysts in the anterior interhemispheric space.

LESSONS

Minimally invasive approaches are an excellent alternative for patients with NCC, especially if a patient requires more than one surgery.

Neurocysticercosis With Internal Carotid Artery and Middle Cerebral Artery Vasculitis and Stenosis

A seven-year-old female child presented with sub-acute onset headache, vomiting, and aphasia with right-sided upper motor neuron (UMN) type hemiparesis and ipsilateral UMN type facial nerve weakness. Her coagulation profile and thrombotic profile were normal. MRI brain with magnetic resonance angiography (MRA) detected neurocysticercosis causing secondary vasculitis and narrowing of supraclinoid left internal carotid artery (ICA) and middle cerebral artery (MCA). The patient was given aspirin along with steroids and albendazole. She improved gradually, and her hemiparesis and facial nerve palsy improved completely by three months and aphasia by four months.

Prevalence of neurocysticercosis among people with epilepsy in rural areas of Burkina Faso

PURPOSE

To estimate the lifetime prevalence of neurocysticercosis (NCC)-associated epilepsy and the proportion of NCC among people with epilepsy in three Burkina Faso villages.

METHODS

Three villages were selected to represent three types of pig-rearing methods: (1) Batondo, where pigs are left to roam; (2) Pabré, where pigs are mostly tethered or penned; and (3) Nyonyogo, where the majority of residents are Muslim and few pigs are raised. In Batondo and Nyonyogo, all concessions (a group of several households) were included. Half of the concessions in Pabré were randomly chosen. All households of selected concessions were included, and one person per household was randomly selected for epilepsy screening and serologic testing for cysticercosis. Self-reported cases of epilepsy were also examined and confirmed cases included in analyses other than the estimate of NCC-associated epilepsy prevalence. Epilepsy was defined as ever having had more than one episode of unprovoked seizures. Individuals with medically confirmed epilepsy had a computerized tomography (CT) scan of the brain before and after contrast medium injection. The diagnosis of NCC was made using a modification of the criteria of Del Brutto et al.

KEY FINDINGS

Thirty-nine (4%) of 888 randomly selected villagers and 33 (94%) of 35 self-reported seizures cases were confirmed to have epilepsy by medical examination. Among the 68 participants with epilepsy who had a CT scan, 20 patients were diagnosed with definitive or probable NCC for a proportion of 46.9% (95% confidence interval [CI] 30.2-64.1) in Batondo and 45.5% (95% CI 19.0-74.1) in Pabré. No cases of NCC were identified in Nyonyogo.

SIGNIFICANCE

All the definitive and probable cases of NCC were from the two villages where pig breeding is common. Prevention policies intended to reduce the burden of epilepsy in this country should include measures designed to interrupt the life cycle of Taenia solium.

Disseminated cysticercosis

Disseminated cysticercosis is a rare form of cysticercosis in which the cysticerci spread out through the whole body. We report the first case of a 39-year-old Mongolian with disseminated cysticercosis. He visited our hospital with generalized tonic-clonic seizure. After extensive investigation from brain computed tomography (CT), spine magnetic resonance imaging (MRI), whole body MRI and pathologic biopsy, he was diagnosed as having cysticercosis involving the brain, subcutaneous tissue, and skeletal muscles through the whole body. We treated him with the albendazole in which case the followed MRI showed that numbers of cystic lesions were copiously decreased. We report an unsual case of disseminated cysticercosis treated with medical therapy.

Diagnosis and treatment of neurocysticercosis

Neurocysticercosis, the infection caused by the larval form of the tapeworm Taenia solium, is the most common parasitic disease of the central nervous system and the most common cause of acquired epilepsy worldwide. This has primarily been a disease that remains endemic in low-socioeconomic countries, but because of increased migration neurocysticercosis is being diagnosed more frequently in high-income countries. During the past three decades improved diagnostics, imaging, and treatment have led to more accurate diagnosis and improved prognosis for patients. This article reviews the current literature on neurocysticercosis, including newer diagnostics and treatment developments.

Hallucinations arising in the context of torn attachment, traumatic childhood and tapeworms

OBJECTIVE

The aim of this paper is to describe the processes underlying psychotic symptoms in an adolescent who presented to our service at the age of 15 years.

CONCLUSION

A teenage female presented having experienced her early childhood in a war-torn third-world country, during which time her mother died, and she suffered worm infestation, neglect and trauma, before being adopted by a family in a developed country, where she lived for several years prior to relocating to Australia. The presenting complaints included longstanding anxiety, depressive and dissociative symptoms, with subsequent behavioural problems and learning difficulties. More recently, she had developed auditory hallucinations, and the antipsychotic she had been taking was beneficial. An MRI of the brain demonstrated lesions in keeping with healed parasitic disease (neurocysticercosis). The patient's hallucinations are discussed in the context of the relationship between a traumatic childhood and psychosis, and neurocysticercosis. Within months of her presentation, the hallucinations resolved as her step-mother became more available. Her antipsychotic medication is being carefully decreased, and the patient is engaging in psychological therapies to deal with her past trauma and disrupted attachment.

Causes of childhood epilepsy in Vietnam: cases in Bach Mai Hospital

BACKGROUND

Little is known about childhood epilepsy in Vietnam, and because the causes of symptomatic epilepsy could be the result of both rapid economic development and traditional Vietnamese lifestyle, the purpose of the present paper was to clarify the nature of childhood epilepsy in Vietnam.

METHOD

A classification of epilepsy using International League Against Epilepsy classification was made and an investigation of causes was carried out.

RESULTS

Of those 162 new patients diagnosed as having epilepsy in Bach Mai Hospital, Hanoi, Vietnam, from February 2002 to February 2004 (male 84, female 78), there were 58 cases of generalized epilepsy: 22 symptomatic and 36 idiopathic or cryptogenic. A total of 90 patients were diagnosed as having localization-related epilepsy: 53 as symptomatic and 37 as idiopathic or cryptogenic. A total of 14 cases were also considered as not epileptic after strict review of both the history and the examination data.

CONCLUSION

Concerning the causes, the following were noted: (i) the rate of infectious diseases and trauma as causes of epilepsy was considerably higher in Vietnam than in developed countries; (ii) certain infectious diseases could be prevented if vaccinations and public health knowledge were improved; and (iii) the number of trauma cases, mainly due to traffic accidents, would likely be reduced if the traffic system was improved.

Magnetic resonance imaging in the diagnosis of subretinal cysticercosis

PURPOSE

To report a case of ocular cysticercosis and associated magnetic resonance imaging (MRI) findings.

DESIGN

Interventional case report.

METHODS

A 56-year-old woman from Ecuador presented with decreased vision and an exudative retinal detachment in the left eye. Subretinal cysticercosis was suspected.

RESULTS

In the left eye, a subretinal cyst evident on fundus examination was investigated with B-scan ultrasonography. Ultrasonography showed a cystic structure, and MRI of the orbit confirmed the suspicion for cysticercosis. Magnetic resonance imaging of the brain also revealed a small parenchymal lesion in the left occipital lobe of the brain.

CONCLUSIONS

Magnetic resonance imaging is a useful adjunct to B-scan ultrasonography in the diagnosis of ocular cysticercosis. Magnetic resonance imaging is superior to computed tomography in the demonstration of cystic structures in the eye and central nervous system. This finding has important therapeutic implications, as any viable cysticercus in the eye or cerebral parenchyma can be treated surgically or medically, respectively.