Aspectos clínicos e evolutivos da hidrocefalia na neurocisticercose

Abstract

RESUMO -Com o propósito de analisar os aspectos clínicos da hidrocefalia (HDC) na neurocisticercose (NCC), realizou-se o estudo retrospectivo de 47 prontuários de pacientes com HDC e NCC. Verificou-se que 70,2% eram homens, entre 21 e 50 anos. A hipertensão intracraniana (HIC) ocorreu em todos os pacientes, cefaléia (CEF) em 89,4%, meningoencefalite (ME) em 80,8% e distúrbios psíquicos (PSI) em 74,5%. A síndrome liquórica da NCC foi detectada em 65,9% pacientes. Além da HDC, as tomografias computadorizadas de crânio (TC) mostraram lesões císticas e edema cerebral difuso em 59,6% cada, calcificações em 55,3%. Dos 41 pacientes (87,2%) com derivação ventriculoperitoneal (DVP), em 22 (53,7%) deles foram necessárias uma a sete revisões/paciente (média=3). A evolução foi satisfatória em 51,1% e fatal em 31,9%. Conclui-se que a hidrocefalia é mais comum no sexo masculino em idade produtiva, tendo a HIC, CEF, MN e PSI como manifestações freqüentes e que, a necessidade de revisões de DVP, piora o prognóstico. PALAVRAS-CHAVE: aspectos clínicos, hidrocefalia, neurocisticercose.clinical and evolutive aspects of hydrocephalus in neurocysticercosis ABSTRACT -With the purpose to verify clinical aspects of hydrocephalus (HC) in patients with neurocysticercosis (NCC), a retrospective study of 47 patients was performed. The majority of patients (70.2%) were men aging 21-50 years. Intracranial hypertension (ICH) occurred in all patients, headache (HA) in 42 (89.4%), meningoencephalitis (ME) in 38 (80.8%) and psychiatric disorders (PD) in 34 (72.3%). The cerebrospinal fluid syndrome of NCC was detected in 31 patients (65.9%). In addition to HC, computed tomography (CT) scans showed cystic lesions in 28 (59.6%) patients, diffuse brain edema also in 28 (59.6%), and calcifications in 26 (55.3%). Shunts were inserted in 41 (87.2%) patients and 22 (53.7%) of them were submitted to 1-7 surgical revision/patient (mean=3) that were higher (mean=4) in those who died than in survivors (mean=2). Evolution was satisfactory in 24 (51.1%) patients and fatal in 15 (31.9%). It is possible to conclude that, in patients with NCC, HC occurs predominantly in men in productive life with ICH, HA, ME and PD as common manifestations, and the need for shunt revision makes patient's prognosis worse. A ventriculomegalia (VM) ou hidrocefalia (HDC), como é mais conhecida, caracteriza-se por aumento de volume do líquido cefalorraqueano (LCR) associado a dilatação dos ventrículos cerebrais. Dependendo do mecanismo responsável pela formação dessa dilatação, classifica-se em HDC ex-vácuo (VM conseqüen-te à perda de parênquima cerebral sem alteração na pressão liquórica), HDC de pressão normal (VM conseqüente à redução da vazão liquórica por defeito na absorção de LCR e/ou insuficiência do espaço subaracnóideo), HDC comunicante (VM conseqüente à secreção excessiva de LCR, insuficiência venosa ou alteração da absorção do LCR) e HDC não-comunicante ou obstrutiva (VM conseqüente à obstrução do fluxo liquórico causada pela presença de processo expansivo ou por fibrose ...

Experimental encephalitis caused by Taenia crassiceps cysticerci in mice

“…In spite of that, the inflammation composed mainly by polymorphonuclear cells associated with edema, perivasculitis, and meningitis in BALB/c mice was significantly greater than what was observed in the C57BL/6 ones during the experimental period. Fragoso et al 9 , when inoculating BALB/c mice via intraperitoneal with T. crassiceps cysticerci, observed that they presented a greater parasitary burden than C57BL/6 mice and antigens from the parasite are enough to cause those reactions, even without the inflammatory reaction in the cavity [20][21][22] . The activation and proliferation of the microglia, which is named microgliosis, were discretely higher in C57BL/6 mice throughout the experiment.…”

Clinical Symptoms, Imaging Features and Cyst Distribution in the Cerebrospinal Fluid Compartments in Patients with Extraparenchymal Neurocysticercosis

“…Hydrocephalus is a major concern for patients with extraparenchymal neurocysticercosis, because ventricular-peritoneal shunts have been plagued with high rates of malfunction and risk of infection. The higher the number of surgical revisions needed, the higher the overall mortality [42, 43]. …”

Effect of Albendazole Treatment in an Experimental Model of Neurocysticercosis-Induced Hydrocephalus

“…The management of NCC-related hydrocephalus is also more challenging than that of hydrocephalus of other etiologies because of the higher rates of shunt malfunction, infection, and the need for reoperation. [8][9][10][11] Albendazole is a well-established drug for the treatment of neurocysticercosis. Although some controversy regarding the safety of albendazole in the treatment of extraparenchymal NCC has arisen in the last decades, albendazole remains the drug of choice even for giant extraparenchymal cysts with a mass effect.…”