Active neurocysticercosis, parenchymal and extra parenchymal: A study of 38 patients

Abstract

In this retrospective study we have analysed a series of 38 patients seen from 1983 to 1992 (mean follow-up, 4.5 years) with active neurocysticercosis (NCC), 23 (60.5%) with parenchymal and 15 (39.5%) with extraparenchymal NCC. Classification into these two forms of NCC was based on computed tomography and magnetic resonance imaging criteria. The enzyme-linked immunosorbent assay performed in cerebrospinal fluid, for anti-Taenia solium antibodies, was positive in 18 of 23 (78%) cases. Epilepsy and/or intracranial hypertension were the most common clinical presentation (92%). Twenty-three (60.5%) of 38 patients were treated with praziquantel and/or albendazole. In parenchymal NCC, the efficacy of medical therapy was complete in 13 of 16 (81%) and partial in 3 of 16 (19%) patients. In contrast, in all cases of extraparenchymal NCC treated with cysticidal drugs the results were disappointing. A ventriculoperitoneal shunt was performed in 9 of 13 patients with extraparenchymal NCC and hydrocephalus. Severe complications, including two deaths, associated with the natural evolution of the disease or with surgery, occurred only in extraparenchymal NCC. Therefore, we confirm the existence of the two forms of active NCC, parenchymal and extraparenchymal, which are strikingly different in clinical presentation, medical therapy response, complications, morbidity and mortality.

Discrimination between active and inactive neurocysticercosis by metacestode excretory/secretory antigens of Taenia solium in an enzyme-linked immunosorbent assay.

“…Finally, antibodies titers may be helpful in monitoring the biologic stage of the parasite in cases of extraparenchymal cysts in which the results of medical therapy are difficult to evaluate. 39,40 …”

Clinical Diagnoses of Neurocysticercosis

“…The clinical manifestations of parenchymal NCC are quite different from those of extraparenchymal NCC [11,12]. When the parasites are localized in the parenchyma, the main clinical manifestations are epileptic seizures or focal neurological deficits; if the parasites are localized inside the ventricles or the subarachnoid location there are signs and symptoms of cranial hypertension syndrome, cranial nerves abnormalities and hydrocephalus [12].…”

Forma tumoral de neurocisticercose: relato de caso

“…É uma doença pleomórfica, que assume várias formas de apresentação e evolução clí-nicas, na dependência do número, localização, tamanho, fase evolutiva e tipo de cisticerco e da reação imune individual do hospedeiro 2,3 . Hipertensão intracraniana (HIC) ocorre em 11-51% dos casos de NC 1,2,[4][5][6][7] , originada pela formação de cistos gigantes intraparenquimatosos (forma tumoral), hidrocefalia ou edema cerebral difuso, em decorrência de grande quantidade de cistos e/ou reação meningítica 4 . Na forma tumoral da doença, que corresponde a 22-67% das formas hipertensivas [8][9][10] , o cisticerco ocupa espaço no parênquima encefálico, exercendo efeito de massa e provocando manifestações clínicas de HIC 2,4,11 .…”