Neurocysticercosis-induced hemiballismus in a child

Cortical Blindness Due to Neurocysticercosis in an Adolescent Patient

Neurocysticercosis (NCC) is a common cause of recent-onset seizures in both adults and children in tropical areas, especially when there is no other suggestion of another underlying neurological disorder. In addition, there have been reports of very rare cases of bilateral cortical blindness caused by this helminth in children. It is still unclear whether healthy adolescents with no pre-existing health problems could be vulnerable to developing such sequelae due to NCC. We report a case of a 14-year-old African boy from Nigeria with bilateral cortical blindness caused by NCC due to Taenia solium. According to the boy’s mother, symptoms began with headaches, vomiting, fatigue, visual loss, and fever (40.0 °C). Clinical investigations led to a diagnosis of cortical blindness and encephalitis due to NCC. Appropriate treatment was administered, and it resulted in the resolution of most symptoms, though the patient remained permanently blind.

Acute Movement Disorders in Childhood

Acute-onset movement disorders (MDs) are an increasingly recognized neurological emergency in both adults and children. The spectrum of possible causes is wide, and diagnostic work-up is challenging. In their acute presentation, MDs may represent the prominent symptom or an important diagnostic clue in a broader constellation of neurological and extraneurological signs. The diagnostic approach relies on the definition of the overall clinical syndrome and on the recognition of the prominent MD phenomenology. The recognition of the underlying disorder is crucial since many causes are treatable. In this review, we summarize common and uncommon causes of acute-onset movement disorders, focusing on clinical presentation and appropriate diagnostic investigations. Both acquired (immune-mediated, infectious, vascular, toxic, metabolic) and genetic disorders causing acute MDs are reviewed, in order to provide a useful clinician’s guide to this expanding field of pediatric neurology.

Neurocysticercosis and movement disorders: A literature review

Neurocysticercosis (NCC) is a specific form of cysticercosis that affects the central nervous system. It is caused by the tapeworm Taenia solium, which is often found in pigs. NCC is considered one of the “great simulator/mimickers” of other diseases. In this context, movement disorders (MDs) can occur in a small percentage of individuals with NCC. This review aims to evaluate the clinicoepidemiological profile, pathological mechanisms, and historical features of NCC-associated MD. Relevant reports in six databases were identified and assessed by two reviewers without language restriction. A total of 71 reports containing 148 individuals who developed an MD related to NCC were identified. NCC-associated MD included parkinsonism (n = 47), ataxia (n = 32), chorea (n = 18), dystonia (n = 13), tremor (n = 8), myokymia (n = 6), myoclonus (n = 4), ballism (n = 1), tics (n = 1), and others (n = 18). The mean and median ages were 36.58 (standard deviation: 20.51) and 35 years (age range: 1–88 years), respectively. There was a slight predominance of female sex (52.17%). On follow-up, 58.90% of the individuals had a full recovery; two deaths were reported. We believe that the majority of cases reported were only diagnosed because patients had classical clinical manifestations generally investigated by neuroimaging, resulting in incidental findings suggestive of NCC, which were later supported by laboratory examinations. Therefore, the association between NCC and MD is probably underreported. Clinicians should be wary of this association, mainly in endemic areas for cysticercosis.

Parkinsonism and other movement disorders in 23 cases of neurocysticercosis

INTRODUCTION

Parkinsonism and other movement disorders have been occasionally described in neurocysticercosis (NCC) but their clinical features and pathogenesis are not well understood.

METHODS

This is a descriptive study conducted over 20 years. We studied 590 consecutive patients from the NCC Registry at Eugenio Espejo Hospital, Quito, Ecuador, and found 23 subjects who developed movement disorders. We investigated the clinical features, localization of brain lesions, severity of infection and neurological deficit as well as the outcome of the patients. Patients were treated with albendazole, dexamethasone, acetazolamide and surgery. We established the diagnosis of NCC, by absolute, imaging and clinical/exposure criteria.

RESULTS

Fifteen patients had parkinsonism, 5 tremor, 2 dystonia and 1 chorea. Patients with chorea and dystonia were young females and had cystic lesions in the thalamus and putamen, respectively. Parkinsonism was more frequent in middle aged subjects with subarachnoid and ventricular cysts, hydrocephalus, brain cysts and frequently abnormal cerebrospinal fluid. After anthelmintic treatment no patient died and all patients with chorea, dystonia and tremor fully recovered; 7 of the 15 patients with parkinsonism required treatment with steroids, surgery and long term l-DOPA therapy.

CONCLUSIONS

Chorea and dystonia in NCC are due to selective lesions of the basal ganglia. Parkinsonism, the most common movement disorder in NCC, is not related to specific localization of the lesions but the patients show widespread and large lesions, associated with inflammation and distortions of brain structures. In patients with NCC, chorea, dystonia, tremor have a better prognosis, Parkinsonism has a worse one.

The Increase of Exotic Zoonotic Helminth Infections: The Impact of Urbanization, Climate Change and Globalization

Zoonotic parasitic diseases are increasingly impacting human populations due to the effects of globalization, urbanization and climate change. Here we review the recent literature on the most important helminth zoonoses, including reports of incidence and prevalence. We discuss those helminth diseases which are increasing in endemic areas and consider their geographical spread into new regions within the framework of globalization, urbanization and climate change to determine the effect these variables are having on disease incidence, transmission and the associated challenges presented for public health initiatives, including control and elimination.

Transient cortical blindness as a manifestation of solitary cysticercus granuloma

Neurocysticercosis is recognised as a significant cause of neurological morbidity in endemic regions. The wide range of pleomorphic and non-specific neurological manifestations of neurocysticercosis must be kept in mind by physicians, as the disease has shown resurgence in developed countries. When an atypical presentation of an unusual tropical disease occurs in non-endemic regions, the diagnosis is often missed. We describe a case of a 4-year-old girl who presented with a history of transient bilateral loss of vision with headache and vomiting. Brain MRI revealed the presence of a single cysticercus granuloma in the occipital lobe. A diagnosis of symptomatic occipital lobe seizure secondary to neurocysticercosis was made. She was given a course of albendazole. There was no recurrence of symptoms at 3 years follow-up. Occipital seizures that are associated with ictal amaurosis closely mimic basilar migraine. Such cases benefit from neuroimaging in order to rule out the underlying structural causes.