A Proposal for Classification of Neurocysticercosis

Abstract

The complicated pathophysiological and immunological changes in the central nervous system of patients with neurocysticercosis produce a variety of signs and symptoms, which complicate the clinical and surgical management of this disease. A complete and objective classification is needed, to improve the medical approach as a whole. We studied 336 patients, in whom we classified neurocysticerosis according to criteria of viability and location of the parasite in the CNS: active form (37.2%) when the cysticercus is alive, transitional form (32.8%) when it is in the degenerative phase, and inactive form (30%) when the parasite is dead. This classification establishes the correlation between the different forms of neurocysticerosis and its clinical manifestations, and can be used for planning therapeutic strategies.Resume: La neurocysticerose : ebauche de classification. Les changements physiopathologiques et immunologiques complexes du systeme nerveux central chez les patients atteints de neurocysticercose donnent lieu a des signes et a des symptomes varies qui compliquent le traitement clinique et chirurgical de cette maladie. Nous avons besoin d'une classification complete et objective de la neurocysticercose afin d'ameliorer l'approche medicale globale. Nous avons etudie 336 patients atteints de neurocysticercose, dont nous avons classifie la maladie selon des criteres de viabilite et de localisation du parasite dans le systeme nerveux central : la forme active (37.2%) quand le cysticerque est vivant, la forme transitionnelle (32.8%) quand le parasite est en phase degenerative et la forme inactive (30%) quand le parasite est mort. Cette classification etablit la correlation entre les differentes formes de neurocysticercose et leurs manifestations cliniques et peut etre utilisee pour planifier des strategies therapeutiques.Can. J. Neurol. Sci. 1994; 21: 43-47 Human cysticercosis, or larval stage of the Taenia solium, is the most common parasitic illness that affects the central nervous system (CNS), especially in countries where the sanitary infrastructure is deficient. In Latin American countries, the frequency of neurocysticercosis (NC) is very high, reaching 3.6% in some regions, 1 and it is becoming increasingly common in developed countries, because of immigration from endemic regions. 2 We find it even in communities which do not eat pork and whose residents have not traveled to a country where T. solium infection is endemic.3 Since NC is a great public health problem, it is important to have a clear understanding of this disease in order to implement the necessary preventive measures.The natural history of the cysticercus in the CNS is, to date, not completely known; however, the CT scan in the last decade, and now the MRI, 4 have been very useful in the study of the biologic evolution of the cysticercosis in the CNS, especially in the brain parenchyma. Many authors have described the CT appearance of parenchymal lesions of NC related to the stage of the larva.5-9 When the larva is alive, the ...

Case-control study of seropositivity for cysticercosis in Cuenca, Ecuador.

“…13 There are several reasons for this. First, in prior studies, the EITB test was used as the standard to which the cerebral CT scan has been compared for sensitivity and specificity in the diagnosis of neurocysticercosis.…”

“…Neurocysticercosis was classified by type of lesion under the criteria proposed by Carpio and others. 13 Lesions seen on CT were classified as follows: 1) active cysticercosis: one or more rounded and hypodense areas of variable size seen without enhancement with contrast media; 2) transitional: one or more cystic areas, isodense with surrounding cerebral parenchyma, appearing only with administration of contrast media as nodular or annular forms; and 3) inactive cysticercosis: rounded, hypodense lesions, seen without contrast media, that had one or more areas of calcification.…”

Taenia antigens detection in the cerebrospinal fluid of patients with neurocysticercosis and its relationship with clinical activity of the disease

“…The clinical picture of NC is dominated by epileptic seizures, but a wide range of neurological symptoms can occur [12][13][14][15] . Epileptic seizures occur more often at the transitional stage of the cysts, but can also occur at the calcified stage, the so-called inactive form [16][17][18] . In a recent consensus proposing diagnostic criteria for NC, several images were emphasized and classified as absolute, major and minor criteria 19 .…”

A Pain in the…Ventricle

“…1,2 NCC symptoms depend on cyst location and whether they are viable (as in our patient), degenerating or inactive. 3 Medical management is controversial and may lead to ependymal inflammation from cyst death. If treatment is pursued, dexamethasone may decrease the inflammatory response.…”