[The tumoral form of cerebellar schistosomiasis: case report and measure of granulomas]

An unusual case of the tumoral form of cerebellar Schistosomiasis mansoni, in a 15 year-old male diagnosed by biopsy, with neurological signs and symptoms 60 days prior to surgery. Computerized tomography show a hyperdense expanding lesion located in cerebellum, suggesting glioma. Histopathological examination showed numerous S. mansoni ova involved by granulomatous inflammation in necrotic-exudative phase, located mainly in the internal, granular layer of the cerebellum, creating a pseudotumor in the cerebellar vermis and a recent hemorrhage in the trunk. The areas of granulomas were measured.

Hydatid cysts of the internal acoustic canal and jugular foramen

Brain involvement with hydatid disease occurs in 1-2% of all Echinococcus granulosus infections. Cerebral hydatid cysts are usually supratentorial, whereas infratentorial lesions are quite rare. Here we report a 19-year-old man with hydatid cysts in the right cerebellopontine cistern with the involvement of internal acoustic canal and jugular foramen. The patient presented with signs of increased intracranial pressure and multiple cranial nerve palsies. Surgery was performed in the semi-sitting position using a lateral suboccipital approach for a right-sided craniotomy. Magnetic resonance imaging clearly demonstrated cisternal, neural and vascular relationships which aided in intact surgical removal of the lesion using microsurgical techniques. Total removal without rupture should be the surgical goal in all hydatid cysts.

Oral cysticercosis

Cysticercosis is the result of infection with the larval stage of the tapeworm, Taenia solium. The parasite may settle at any site in the body without causing symptoms, which arise almost exclusively from the involvement of brain or eye, and this may occur several years after infection. Cysticercosis is one of the leading causes of acquired epilepsy in Latin America, parts of Asia, and Africa. More cases are being reported in other countries as a result of immigration from endemic areas. Cysticercosis may cause cystic swellings or nodules in the mouth, and these may be the only evidence of the disease. We present a healthy patient who had multiple intraoral cystic swellings that were diagnosed as cysticercosis in a biopsy specimen. Subsequent investigations showed cysticerci in the brain.

Neuropathological observation of rabbits (Oryctolagus cuniculus) affected with raccoon roundworm (Baylisascaris procyonis) larva migrans in Japan

Larvae of the raccoon roundworm, Baylisascaris procyonis (B. procyonis) are a known cause of cerebrospinal larva migrans in animals and humans. The present paper described details of the central nervous lesion in the rabbits (Oryctolagus cuniculus) affected with B. procyonis larva migrans in Japan. Clinically affected animals showed neurological signs including circling, torticollis, tremor of head, or ataxic gait. The most characteristic pathological alterations were large malacic lesions associated with an activated astroglial proliferation which was seen at the corpus medullare in the cerebellum including the cerebellar peduncle. Moreover, focal malacic lesions with perivascular cuffing and infiltration by lymphocytes and heterophiles were scattered everywhere throughout the brain. In these lesions or normal-appearing areas away from obvious lesions, ascarid larvae, about a maximum 65-75 micro m in diameter, were recognized. Other prominent features were minute lesions (we call them migration tract-like lesions) composed of lymphocytes, hemosiderin-laden macrophages and reactive astrocytes scattering throughout the cerebrum. In this study, we demonstrated ascarid larvae in only eight out of 23 animals diagnosed as B. procyonis larva migrans. Since it is not always possible to detect the larvae, the possibility of B. procyonis larva migrans must be given serious consideration to the characteristic lesions described above.

[Unusual cause for bilateral trigeminal neuralgia: unilateral racemous cysticercus of cerebellopontine angle. Case report]

We report the case of a 42-year-old woman with a racemous cystecercus in the right cerebellopontine angle (CPA), who presented with bilateral trigeminal neuralgia. The parasite was completly removed via a right suboccipital craniotomy. On the first postoperative day, the patient indicated that the pain disappeared. The neuralgia was caused by two probable mechanisms: a distortion of the brain stem and compression of the nerve against an arterial loop at the entry zone or arachnoiditis caused by the parasite in the both CPA cisternae. This case demonstrates the advisability of obtaining imaging studies in all patients with trigeminal neuralgia before starting any management. We must always remind that the cysticercus may be a differential diagnosis of CPA lesions.

[The sleep-wake cycle during Trypanosoma brucei rhodesiense human African trypanosomiasis in 2 French parachutists]

Polysomnography was performed in two military personnel who contracted human African trypanosomiasis (HAT) in Rwanda. They were evacuated to France and gramined during the fourth, sixth and eleventh months of evolution. Patient A presented a meningoencephalitis with Trypanosoma brucei rhodesiense (T. b. r.) in the cerebrospinal fluid. Between the second and third treatments with melarsoprol, the patient presented an acute encephalitic attack with pyramidal and cerebellar symptoms, which were improved by corticotherapy and disappeared progressively in 6 months. Patient B presented a major inflammatory syndrome with T. b. r. in the blood and the medulla. Cerebrospinal fluid and serology remained normal. The patient received only one session of melarsoprol treatment. Polysomnography recordings were continuously taken on an ambulatory Oxford Medilog system during 48 hours. The different stages of vigilance were scored according to the classical Rechtschaffen and Kales criteria. During the fourth month, both subjects presented several long diurnal naps, with the presence of rapid-eye-movement sleep at the end of the sleep episodes. These abnormalities disappeared progressively during the following recordings. Electroencephalographic abnormalities were observed in patient A, particularly during the eleventh month. They consisted in transitory arousal phases concomitant with myoclonic jerks and with the persistence of slow waves during slow-wave sleep. The various anomalies noted in the two patients allow us to recommend the supervision of the evolution of HAT by polysomnographic recording in a sleep laboratory.

[Hydatidosis of the posterior fossa]

The hydatid cyst is an endemic zoonosis in Spain. The central nervous system is seldom affected, the hydatid cyst in cerebellum being very rare. A patient with hydatid cyst affecting the vermis and right cerebellar hemisphere is presented. The case is described and discussed. The use of CT scan is encouraged as the most worthwhile election of diagnosis techniques. We highlight the need for very careful surgical treatment, preserving the hydatid cyst complete, to avoid relapses and to prevent the change of a benign disease to a chronic one with very high mortality.

Central nervous system cysticercosis simulating an acute cerebellar hemorrhage

We report the case of a Mexican man who suddenly developed severe occipital headache, vomiting, vertigo, and ataxia. Neurologic examination showed nystagmus and cerebellar findings. Computed tomography of the brain demonstrated a large left cerebellar cystic lesion consistent with the diagnosis of cysticercosis. The patient was treated with dexamethasone and praziquantel and required surgical removal of the lesion to prevent herniation. He recovered without neurologic sequelae. The abrupt onset of cerebellar findings is an unusual presentation of this disease. Central nervous system cysticercosis is being recognized with increasing frequency in the United States, where it is found primarily in Hispanic and Asian immigrants. The literature of central nervous system cysticercosis is reviewed and the pathogenesis, clinical presentation, and therapy are discussed.

The tumoral form of schistosomiasis: report of a case with cerebellar involvement

The tumoral form of schistosomiasis mansoni is rare and has not been described in the brain, in which schistosome eggs usually elicit a granulomatous inflammation. A 20-year-old Brazilian man had the tumoral form of schistosomiasis of the cerebellum which was treated surgically. Histological study of the excised cerebellar mass demonstrated a massive granulomatous reaction around Schistosoma mansoni eggs and massive necrotic areas. To our knowledge, this is the first case of schistosomiasis mansoni of the brain presenting as a posterior fossa mass with the characteristic necrotic granulomas.