Objective-To determine the frequency and features of psychiatric morbidity in a cross section of 38 outpatients with neurocysticercosis. Methods-Diagnosis of neurocysticercosis was established by CT, MRI, and CSF analysis. Psychiatric diagnoses were made by using the present state examination and the schedule for affective disorders and schizophrenia-lifetime version; cognitive state was assessed by mini mental state examination and Strub and Black's mental status examination. Results-Signs of psychiatric disease and cognitive decline were found in 65-8 and 87-5% of the cases respectively. Depression was the most frequent psychiatric diagnosis (52-6%) and 14-2% of the patients were psychotic. Active disease and intracranial hypertension were associated with higher psychiatric morbidity, and previous history of mood disorders was strongly related to current depression. Other variables, such as number and type of brain lesions, severity of neuropsychological deficits, epilepsy, and use of steroids did not correlate with mental disturbances in this sample. Conclusions-Psychiatric abnormalities, particularly depression syndromes, are frequent in patients with neurocysticercosis. Although regarded as a rare cause of dementia, mild cognitive impairment may be a much more prevalent neuropsychological feature of patients with neurocysticercosis. The extent to which organic mechanisms related to brain lesions may underlie the mental changes is yet unclear, although the similar sex distribution of patients with and without depression, as well as the above mentioned correlations, provide further evidence of the part played by organic factors in the cause of these syndromes. (J Neurol Neurosurg Psychiatry 1997;62:612-616)
SUMMARY -Three hundred land fifty seven computed tomography (CT) from 100 different patients with neurocysticercosis (NC) were studied between 1979 and 1988. All patients were treated with praziquantel (PZQ).A new classification attempting to recognize the CT evolution profile in NC as well as assigning a possible link between CT findings and biological conditions of cysts is evaluated.It was possible to conclude that: intact cysts remain unchanged in consecutive CTs by 11 months and exhibit signs of degeneration in about 18 months after PZQ drug therapy; degenerating cysts can be detected by 10.5 months, disappear in 11 months and become nodular calcifications in about 25 months.Therefore, a time period of at least 36 months can be estimated for the complete evolution profile of cysts in the brain parenchyma.Tomografia computadorizada na neurocisticercose: análise da evolução em 100 pacientes durante 10 anos e avaliação de nova classificação. RESUMO -Foram estudados 357 exames por tomografia computadorizada do crânio (TC)de 100 pacientes com neurocisticercose, tratados com praziquantel (PZQ) entre 1979 e 1988. Foi utilizada nova classificação tomográfica, procurando estabelecer vincule entre as imagens observadas à TC e a evolução biológica dos cisticercos.Considerando-se como estimador o valor das medianas em meses após o tratamento com PZQ, foi possível concluir que: vesículas íntegras permanecem inalteradas em exames consecutivos por período de 11 meses; apresentam sinais radiológicos sugestivos de processo inflamatório, geralmente associados à degene¬ ração de cisticercos, em período de 1S meses; estas vesículas em degenerarão podem ser detectadas durante 10,5 meses, desaparecem em 11 meses e evoluem para calcificações nodu¬ lares simples em 25 meses. De acordo com este critério, pode ser estimado período mínimo de 36 meses para o perfil de evolução de cisticercos no parênquima cerebral em pacientes tratados com PZQ.Advances in the study of neurocysticercosis (NC) have been favoured in the last decade by the current use of computed tomography brain scan (CT). Cysts and calcifications were recognized as the two most common and important types of CT images suggesting the presence of the cysticerci in the brain parenchyma 9.In this same period drug therapy for the aetilogical agent through praziquantel (PZQ) has been introduced, favouring interest on the study of CT images in NC. In fact, comparison among CT images before and after PZQ therapy has been often referred to evaluate the effectiveness of the drug 6,12,14.However, such an interpretation may be hazardous since it is possible to admit that the disappearance of cysts might not be
Foram estudadas 5 crianças com subnutrição grave por ocasião da admissão, durante a recuperação e por ocasião da cura clínica. Em cada ocasião foram estudados: peso, estatura, teores de hemoglobina e colesterol, glicemia ,eletroforese de proteínas, teste de Gesell, dados de exame neurológico, pneumencefalograma, eletrencefalograma e líquido cefalorraqueano. Apesar de recuperação clínica e bioquímica muito satisfatória, o teste de Gesell mostrou pequena recuperação neuropsicomotora no último estudo em comparação com o grave retardo global observado à admissão. Todos os pacientes apresentavam atrofia cortical difusa no primeiro estudo pelo pneumencefalograma: três dos 4 pacientes submetidos a novo exame após a cura clínica ainda apresentavam a referida alteração. Os estudos eletrencefalográficos e de líquido céfalorraqueano não evidenciaram alterações praticamente em todos os estudos.
RESUMO -Objetivo: Investigar a ocorrência e os fatores de risco para morbidade depressiva em uma amostra de 38 pacientes ambulatoriais com neurocisticercose. Métodos: O diagnóstico psiquiátrico baseou-se nos exames do estado mental atual e pregresso, respectivamente obtidos pelas entrevistas estruturadas do PSE-9 e SADS-L; as funções cognitivas foram avaliadas pelo MMS e pelo roteiro de Strub & Black (Mental Status Examination). Resultados: Transtornos depressivos foram o achado psiquiátrico mais frequente (63,1%) entre os pacientes da amostra. Destes, 20 (52,6%) mostravam-se deprimidos no momento da avaliação e 4 apresentaram depressão no passado. Entre os pacientes deprimidos, 16 preencheram critérios diagnósticos do DSM-III-R para transtorno orgânico do humor (k = 0,4). Antecedentes pessoais de depressão (p = 0,006), sinais de atividade da doença (p = 0,044) e ocorrência de hipertensão intracraniana (p=0,065) foram os parâmetros clínicos que se correlacionaram com a presença de depressão. Conclusões: Tais achados, aliados à ausência de predomínio do sexo feminino entre os casos de depressão, sugerem etiologia orgânica. Os autores discutem essas observações à luz da literatura sobre outros transtornos mentais orgânicos. PALAVRAS-CHAVE: neurocisticercose, transtornos (distúrbios) mentais orgânicos, depressão.Depressive disorders associated with neurocysticercosis: prevalence and clinical correlations ABSTRACT -Objective: To determine the frequency and features of psychiatric morbidity in a cross-section of 38 outpatients with neurocysticercosis. Methods: Diagnosis of neurocysticercosis was established by CT scan, MRI and CSF analysis. Psychiatric diagnoses were made by using the Present State Examination and the Schedule for Affective Disorders and Schizophrenia -Lifetime version; cognitive state was assessed by Mini-Mental State Examination and Strub & Black's Mental Status Examination. Results: Depression was the most frequent psychiatric diagnosis (52.6%) as shown by PSE. Active disease and intracranial hypertension were associated with higher psychiatric morbidity, and previous history of mood disorders was strongly related to current depression. Conclusions: Depression syndromes are frequent in patients with neurocysticercosis. The extent to which organic mechanisms related to brain lesions may underlie the observed mental changes is yet unclear, though the similar sex distribution of patients with and without depression, as well as the above mentioned correlations, provide further evidence of the role played by organic factors in the cause of these syndromes. The results of this study are discussed in the light of the data available for other organic psychiatric disorders.KEY WORDS: neurocysticercosis, organic mental disorders, depression.A neurocisticercose (NCC) é a mais comum das parasitoses do sistema nervoso central (SNC) humano 1 e corresponde à infestação dele pela forma larvária do cestóide Taenia solium. É doença própria dos países ou regiões onde há contaminação dos rebanhos suínos, consumo de c...
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