ObjectThe prognosis for intraventricular neurocysticercosis (IVNCC) is poorer than that for parenchymal NCC, making prompt diagnosis and treatment especially important. Although active, viable intraventricular cysts produce no reaction in the host; they can cause noncommunicating hydrocephalus, the onset of which is frequently abrupt. With the death of the larva comes a local granulomatous ependymitis, generalized ventriculitis, and meningoencephalitis. The authors report on 18 patients with IVNCC (accrued from a larger case series of 62 patients with NCC treated over an 11-year period), detailing clinical presentation, neuroimaging findings, treatment, and outcome.MethodsAll patients presented with hydrocephalus and/or meningitis. The most valuable diagnostic tests were magnetic resonance imaging of the brain and EITB of serum and/or cerebrospinal fluid. Treatment included albenda-zole and steroid therapy in all cases, and when necessary in cases requiring urgent or emergency ventriculostomy and/or surgical removal of the obstructing cyst (followed by shunt placement if indicated).ConclusionsAn extensive review of the literature on IVNCC has been prepared, with the goal of providing the reader with the information necessary to diagnose and treat this complex and potentially fatal disease in a timely and effective manner.
Intraventricular neurocysticercosis is of concern because it is associated with a poorer prognosis than is parenchymatous disease. Frequently, associated hydrocephalus occurs, which may recur after treatment. We report on 11 patients with intraventricular cysticercosis (from a larger case series of 33 patients) and evaluate clinical presentations, neuroimaging findings, and responses to treatment, especially of ventricular disease. Intraventricular cysticercosis represented 33% of our cases. Seven patients presented with increased intracranial pressure; four required ventriculoperitoneal shunting. Parenchymatous symptomatic cysticercosis is largely a result of the host inflammatory response, presenting in our series with epileptic seizures in 73% of the patients (tonic clonic generalized seizures occurred in 64% and partial simple seizures in 9%). The prognosis for parenchymatous inflammatory disease is good. We advocate the use of anthelmintic treatment with albendazole in all cases of intraventricular cysts, and if hydrocephalus occurs, then shunt procedures or ventriculostomy is necessary. These patients must be monitored closely for recurrent hydrocephalus.
This review is an objective critique of the thoracic outlet syndrome, with emphasis on the need to separate true neurogenic and vascular syndromes from nonspecific ones. Major controversies in the diagnosis and management of thoracic outlet syndromes are discussed, with an analysis of major pitfalls encountered in the diagnosis and treatment of patients with nonspecific syndromes. Recommendations to improve diagnostic methods in patients with chronic neurovascular abnormalities in the upper extremities are outlined.
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