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Yang C, Liu T, Wu J, Xie J, Yu T, Jia W, Yang J, Xu Y. Spinal cysticercosis: a rare cause of myelopathy. BMC Neurol 2022; 22:63. [PMID: 35193508 PMCID: PMC8862344 DOI: 10.1186/s12883-022-02589-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background Neurocysticercosis is a neuroinfectious disease caused by the larval stage of the tapeworm Taenia solium. Isolated spinal cysticercosis is rare, with limited cases having been reported in the literature. This entity poses great diagnostic and therapeutic challenges. Methods This retrospective study included seven patients pathologically diagnosed with spinal cysticercosis. The clinical manifestations, radiological features on magnetic resonance imaging (MRI), treatment, and outcomes were analyzed. Results This case series consisted of four male and three female patients, with an average age of 34.9 ± 10.9 years. Clinically, six patients manifested with localization-related myelopathy. There were four solid lesions, one cystic-solid lesion, and three cystic lesions. The solid and cystic-solid lesions showed characteristic MRI features: 1) within the lesion, there was a mural nodule with isointensity on T1WI and iso- to hyperintensity on T2WI; 2) the signals at the periphery of the mural nodule were variable, ranging from hypointense to hyperintense on T2WI; and 3) ring-like or cyst wall enhancement could be present, and dot-like enhancement could be noted in the mural nodule. Complete resection of the responsible lesion was achieved in all patients, and oral albendazole was administered in a patient with one more suspected homologous lesion. After a mean follow-up period of 56.7 ± 35.1 months, the patient’s symptoms mostly regressed. Conclusion Spinal cysticercosis is an extremely rare cause of myelopathy. Characteristic MRI features can facilitate preoperative diagnosis. Clinicians should be aware of this entity, and it should be included in the differential diagnosis of myelopathy.
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Affiliation(s)
- Chenlong Yang
- Department of Neurosurgery, Peking University Third Hospital, Haidian District, Beijing, China.,North America Medical Education Foundation, Union, CA, USA
| | - Tie Liu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Wu
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jingcheng Xie
- Department of Neurosurgery, Peking University Third Hospital, Haidian District, Beijing, China
| | - Tao Yu
- Department of Neurosurgery, Peking University Third Hospital, Haidian District, Beijing, China
| | - Wenqing Jia
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun Yang
- Department of Neurosurgery, Peking University Third Hospital, Haidian District, Beijing, China.
| | - Yulun Xu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Parkhouse RME, Carpio A, Campoverde A, Sastre P, Rojas G, Cortez MM. Reciprocal contribution of clinical studies and the HP10 antigen ELISA for the diagnosis of extraparenchymal neurocysticercosis. Acta Trop 2018; 178:119-123. [PMID: 29155204 DOI: 10.1016/j.actatropica.2017.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/03/2017] [Accepted: 11/15/2017] [Indexed: 11/19/2022]
Abstract
To evaluate diagnosis of active neurocysticercosis, paired cerebral spinal fluid (CSF) and serum samples from 24 neurocysticercosis (NCC) patients and 17 control neurological patients were assayed in the HP10 Taenia antigen (Ag) ELISA. The CSF samples were also tested with an HP10 Lateral Flow Assay (LFA). The HP10 Ag was detected by ELISA in the CSF of 5/5 patients with Definitive extraparenchymal NCC, and in 4/5 of the corresponding sera. In the Definitive parenchymal group, on the other hand, the HP10 Ag was absent in 2/3 CSF (with a very low value in the one positive sample) and all the corresponding serum samples. Samples of CSF from 4/7 patients in the Probable parenchymal group, were also significantly HP10 Ag positive, suggesting the presence of extraparenchymal cysts not identified by the imaging studies. With the possible exception of one patient, the corresponding serum samples of the Probable parenchymal NCC group, were all HP10 Ag negative. Samples of CSF from 9 NCC patients diagnosed with Mixed parenchymal and extraparenchymal NCC were all significantly HP10 Ag positive, confirming the presence of extraparenchymal cysts, with only 7/9 of the corresponding serum samples being HP10 positive. Thus detection of the HP10 Ag indicates extraparenchymal and not parenchymal cyst localization and is more sensitive with CSF than serum. Three neurological patients clinically diagnosed as subarachnoid cyst, hydrocephalus and tuberculoma, respectively, were clearly positive for HP10 Ag. Of these, two were confirmed as NCC by subsequent imaging; the third died prior to further examination. Thus, a total of 8 patients had their clinical diagnosis questioned. Finally, there was good agreement between the HP10 Ag ELISA and LFA with CSF samples giving an optical density ≥0.4 in the ELISA assay. In conclusion, the HP10 Ag assay should provide a valuable and reciprocal tool in the clinical diagnosis and follow up of extraparenchymal NCC.
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Affiliation(s)
- R Michael E Parkhouse
- Institute Gulbenkian de Ciência, Rua da Quinta Grande, 6, 2780-156 Oeiras, Portugal.
| | - Arturo Carpio
- Escuela de Medicina, Universidad de Cuenca, Cuenca, Av. 12 de Abril y Av. Loja, Ecuador; GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
| | - Alfredo Campoverde
- Escuela de Medicina, Universidad de Cuenca, Cuenca, Av. 12 de Abril y Av. Loja, Ecuador.
| | | | - Glenda Rojas
- Escuela de Bioanálisis, Facultad de Ciencias de la Salud, Edo. Aragua. Universidad de Carabobo, Venezuela; Instituto de investigaciones Biomédicas "Dr. Francisco J. Triana-Alonso" Facultad de Ciencias de la Salud, Edo. Aragua. Universidad de Carabobo, Venezuela.
| | - María Milagros Cortez
- Instituto de investigaciones Biomédicas "Dr. Francisco J. Triana-Alonso" Facultad de Ciencias de la Salud, Edo. Aragua. Universidad de Carabobo, Venezuela.
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Bazan R, Odashima NS, Luvizutto GJ, Hamamoto Filho PT, Zanini MA, Takayanagui OM. Analysis of cerebrospinal fluid in racemose form of neurocysticercosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:852-5. [PMID: 26291994 DOI: 10.1590/0004-282x20150120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 08/03/2015] [Indexed: 11/22/2022]
Abstract
The present work aimed to evaluate the pattern of CSF alterations in patients diagnosed with neurocysticercosis (NCC) in racemose form.Method This is a retrospective cohort study of patients with diagnosis of NCC in racemose form. CSF samples from 26 patients were analyzed. After patient-chart analysis was performed descriptive analysis of case studies and comparison between sexes in relation to variables were obtained with CSF by Mann-Whitney and Student's t-tests.Results The sexes did not differ statistically when compared to pleocytosis in CSF. Eosinophils were present in 31% in samples while the ELISA test presented 80% sensitivity in this case series. Of the patient total, 24 presented a meningitis pattern with lymphocytic predominance.Conclusion There was no difference in inflammatory pattern between the sexes, with predominance of lymphocytic meningitis and 80% sensitivity by ELISA test of CSF patients with racemose form of NCC.
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Affiliation(s)
- Rodrigo Bazan
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, BR
| | - Newton Satoru Odashima
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirao Preto, SP, BR
| | - Gustavo José Luvizutto
- Hospital de Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, BR
| | - Pedro Tadao Hamamoto Filho
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, BR
| | - Marco Antonio Zanini
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, BR
| | - Osvaldo Massaiti Takayanagui
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirao Preto, SP, BR
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Camargo JA, Bertolucci PHF. Quantification of Amino Acid Neurotransmitters in Cerebrospinal Fluid of Patients with Neurocysticercosis. Open Neurol J 2015; 9:15-20. [PMID: 26157521 PMCID: PMC4485325 DOI: 10.2174/1874205x01509010015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 04/01/2015] [Accepted: 05/11/2015] [Indexed: 11/22/2022] Open
Abstract
Background : Neurocysticercosis is a parasitic disease that affects the central nervous system. Its main clinical manifestations are epileptic seizures. The objective of this study was to investigate the correlation between neurotransmitter concentrations in cerebrospinal fluid (CSF) and the different evolutive forms of neurocysticercosis with or without seizures. Methods : Neurotransmitter concentrations (Aspartate, Glutamate, GABA, Glutamine, Glycine, Taurine) were determined in CSF samples from 42 patients with neurocysticercosis divided into patients with the active cystic form (n = 24, 12 with and 12 without seizures) and patients with calcified form (n = 18, 12 with and 6 without seizures), and a control group consisting of 59 healthy subjects. Results : Alterations in amino acid concentration were observed in all patients with neurocysticercosis. Conclusion : We conclude that disturbances in amino acid metabolism accompany the presentation of neurocysticercosis. Replacement of the terms inactive cyst by reactive inactive cyst and calcification by reactive calcification is suggested.
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Affiliation(s)
- José Augusto Camargo
- Departamento De Neurologia E Neurocirurgia Da Universidade Federal De São Paulo/Hospital São Paulo, São Paulo, Brasil
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Machado LDR, Livramento JA, Vianna LS. Cerebrospinal fluid analysis in infectious diseases of the nervous system: when to ask, what to ask, what to expect. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:693-8. [DOI: 10.1590/0004-282x20130153] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cerebrospinal fluid (CSF) analysis very frequently makes the difference to the diagnosis, not only in relation to infections but also in other diseases of the nervous system such as inflammatory, demyelinating, neoplastic and degenerative diseases. The authors review some practical and important features of CSF analysis in infectious diseases of the nervous system, with regard to acute bacterial meningitis, herpetic meningoencephalitis, neurotuberculosis, neurocryptococcosis, neurocysticercosis and neurosyphilis.
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Rodriguez S, Wilkins P, Dorny P. Immunological and molecular diagnosis of cysticercosis. Pathog Glob Health 2013; 106:286-98. [PMID: 23265553 DOI: 10.1179/2047773212y.0000000048] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Cysticercosis, the infection with the larval stage of Taenia solium, is a cause of neurological symptoms including seizures, affecting the quality of life of patients and their families. Diagnosis focuses on brain imaging and serological tests are mostly used as confirmatory tools. Most cases, however, occur in poor endemic areas, where both kinds of diagnostic tools are poorly available. Development of point of care diagnostic tests is one of the most important priorities for cysticercosis researches today. The ideal point of care test would require detection of viable cysticercosis and hopefully identify cases with severe or progressive forms of neurocysticercosis, leading to referral of the patient for specialized medical attention. This manuscript describes the evolution of the serological diagnosis of cysticercosis over time, and the characteristics of the most common currently available tools, their advantages and disadvantages, and their potential use in future diagnostic tests.
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Affiliation(s)
- Silvia Rodriguez
- Infectious Diseases, Instituto Nacional de Ciencias Neurológicas, Jr. Anchash 1271, Lima 1, Peru.
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Suzuki LA, Rossi CL. Evaluation of cysticercus-specific IgG (total and subclasses) and IgE antibody responses in cerebrospinal fluid samples from patients with neurocysticercosis showing intrathecal production of specific IgG antibodies. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:106-9. [PMID: 23295367 DOI: 10.1590/s0004-282x2013005000002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 09/24/2012] [Indexed: 12/24/2022]
Abstract
In the present study, an enzyme-linked immunosorbent assay (ELISA) standardized with vesicular fluid of Taenia solium cysticerci was used to screen for IgG (total and subclasses) and IgE antibodies in cerebrospinal fluid (CSF) samples from patients with neurocysticercosis showing intrathecal production of specific IgG antibodies and patients with other neurological disorders. The following results were obtained: IgG-ELISA: 100% sensitivity (median of the ELISA absorbances (MEA)=1.17) and 100% specificity; IgG1-ELISA: 72.7% sensitivity (MEA=0.49) and 100% specificity; IgG2-ELISA: 81.8% sensitivity (MEA=0.46) and 100% specificity; IgG3-ELISA: 63.6% sensitivity (MEA=0.12) and 100% specificity; IgG4-ELISA: 90.9% sensitivity (MEA=0.85) and 100% specificity; IgE-ELISA 93.8% sensitivity (MEA=0.60) and 100% specificity. There were no significant differences between the sensitivities and specificities in the detection of IgG-ELISA and IgE-ELISA, although in CSF samples from patients with neurocysticercosis the MEA of the IgG-ELISA was significantly higher than that of the IgE-ELISA. The sensitivity and MEA values of the IgG4-ELISA were higher than the corresponding values for the other IgG subclasses. Future studies should address the contribution of IgG4 and IgE antibodies to the physiopathology of neurocysticercosis.
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Affiliation(s)
- Lisandra Akemi Suzuki
- Department of Clinical Pathology, Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
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Machado LDR. The diagnosis of neurocysticercosis: a closed question? ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 68:1-2. [PMID: 20339642 DOI: 10.1590/s0004-282x2010000100001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Iudici Neto F, Pianetti-Filho G, Araújo RN, Nascimento E. Immunodiagnosis of human neurocysticercosis by using semi-purified scolex antigens from Taenia solium cysticerci. Rev Soc Bras Med Trop 2007; 40:163-9. [PMID: 17568882 DOI: 10.1590/s0037-86822007000200004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Accepted: 02/08/2007] [Indexed: 11/22/2022] Open
Abstract
Crude antigen and semi-purified proteins from scolices of Taenia solium cysticerci were evaluated for the immunodiagnosis of human neurocysticercosis neurocysticercosis. Semi-purified proteins obtained by electrophoresis on polyacrylamide gel and by electroelution were tested by means of the immunoenzymatic reaction against sera from normal individuals and from patients with neurocysticercosis or other parasitic diseases. The 100 kDa protein provided 100% sensitivity and specificity in the immunodiagnosis. When 95 or 26 kDa proteins were used, 95 and 100% sensitivity and specificity were obtained, respectively. The assays involving crude antigen and sera from normal individuals or from patients with neurocysticercosis, diluted to 1:256, gave excellent agreement with those in which 100, 95 or 26 kDa proteins were tested against the same serum samples diluted to 1:64. (Kappa: 0.95 to 1.00). Crude scolex antigen may be useful for serological screening, while 100, 95 or 26 kDa protein can be used in confirmatory tests on neurocysticercosis-positive cases.
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Affiliation(s)
- Francesco Iudici Neto
- Divisão de Epidemiologia e Controle de Doenças, Instituto Octávio Magalhães, Fundação Ezequiel Dias, Belo Horizonte, MG
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Casanova CS, Ribeiro MJSP, Gonçalves RR, Faria LC, Peralta JM, Puccioni-Sohler M. Influence of the cerebrospinal fluid laboratory parameters in the ELISA test for neurocysticercosis using a total cysticerci antigen. ARQUIVOS DE NEURO-PSIQUIATRIA 2006; 64:55-9. [PMID: 16622554 DOI: 10.1590/s0004-282x2006000100012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To evaluate if the cerebrospinal fluid (CSF) parameters may influence the cysticercosis immunoreactivity response in the CSF. CSF samples of 109 patients were analyzed and classified in three groups, according to the neurological manifestations and the reactivity in antibody-enzyme linked immunosorbent assay (Ab-ELISA) testing in CSF for neurocysticercosis (NC): group A, 18 patients with neurological disorders compatible with NC and reactive Ab-ELISA in CSF for NC; group B, 50 patients with neurological disorders non-compatible with NC and reactive Ab-ELISA for NC; group C, 41 patients with neurological disorders non-compatible with NC and non-reactive Ab-ELISA in CSF for NC. The CSF analysis in group A was compatible with NC. The group B in comparison to the groups A and C presents higher frequency and intensity of hypercytosis, presence of red blood cells in CSF, protein concentration and immunological reactive test for other etiological agents (p<0.05). Based on the present data, we suggest that the inflammatory process and high protein concentration may determine false positive reactions in the Ab-ELISA test for NC in the CSF.
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Affiliation(s)
- Cristiane S Casanova
- Neurology Service, Gaffrèe Guinle University Hospital, Federal University of Rio de Janeiro State, Rio de Janeiro, RJ, Brazil
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Arruda GC, Quagliato EMAB, Rossi CL. Intrathecal synthesis of specific immunoglobulin G antibodies in neurocysticercosis: evaluation of antibody concentrations by enzyme-linked immunosorbent assay using a whole cysticercal extract and cyst vesicular fluid as antigens. Diagn Microbiol Infect Dis 2006; 54:45-9. [PMID: 16290026 DOI: 10.1016/j.diagmicrobio.2005.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Accepted: 08/16/2005] [Indexed: 11/23/2022]
Abstract
The demonstration of intrathecal antibody production has proven useful for showing the involvement of the central nervous system (CNS) in several diseases. In the present study, the intrathecal synthesis of cysticercus-specific immunoglobulin G (IgG) antibodies was investigated in 30 patients with neurocysticercosis based on calculation of the specific IgG antibody index (AI(IgG)). An AI(IgG) > or =1.5 was considered to be indicative of intrathecal antibody production. Antibody concentrations in serum and cerebrospinal fluid samples were evaluated using an enzyme-linked immunosorbent assay with 2 antigen preparations from Taenia solium cysticerci, namely, a whole cysticercal extract (TsoW) and the vesicular fluid of the parasite (TsoVF). Intrathecal, cysticercus-specific IgG antibody synthesis was observed in 21 (70%) and 23 (76.6%) patients using the TsoW and TsoVF antigens, respectively. The detection of the intrathecal synthesis of specific antibodies may be a potentially useful tool in establishing the involvement of CNS in cysticercosis.
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Affiliation(s)
- Gisele C Arruda
- Department of Clinical Pathology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), P.O. Box 6111, Campinas 13083-970, São Paulo, Brazil
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Minelli C, Takayanagui OM. Evaluation of intrathecal synthesis of IgG in neurocysticercosis. J Neurol Sci 2005; 238:83-6. [PMID: 16125726 DOI: 10.1016/j.jns.2005.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2004] [Revised: 06/20/2005] [Accepted: 06/27/2005] [Indexed: 11/25/2022]
Abstract
Neurocysticercosis is a world public health problem. An increase in immunoglobulin G (IgG) concentration in the cerebrospinal fluid of patients with neurocysticercosis has been described but the reasons for this finding are unknown. Our hypothesis is that the increase in IgG concentration in cerebrospinal fluid is due to exclusive intrathecal synthesis of IgG and this process is associated with the inflammatory phases of the disease. We studied IgG concentration in cerebrospinal fluid in 16 patients with neurocysticercosis comparing with a control group of 19 patients to verify which pattern of increase in IgG concentration in cerebrospinal fluid occurs in neurocysticercosis. In the neurocysticercosis group, intrathecal synthesis of IgG was detected in 12 (75%) and 5 (31.2%) patients by quantitative and qualitative methods, respectively. When compared with the control group the neurocysticercosis patients had the same pattern of intrathecal synthesis of IgG as multiple sclerosis patients. Intrathecal synthesis of IgG was not associated with any variable indicative of an inflammatory process. We conclude that the increase in IgG concentration in neurocysticercosis is due to intrathecal synthesis, as is also the case for multiple sclerosis, and that this process is not related to the inflammatory stage of NCC.
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Affiliation(s)
- César Minelli
- Department of Neurology, Faculty of Medicine at Ribeirão Preto, University of São Paulo, Av. Bandeirantes, no. 3900, 14048-900 Ribeirao Preto, SP, Brazil
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