Forma tumoral da neurocisticercose: exerese de cisticerco de 70x77 mm e tratamento com praziquantel: relato de caso

Abstract

The authors report a case of a female patient, age 22, who presented episodes of focal seizures, right hemiparesis and dysphasia of five months duration. The neurologic exam revealed bilateral papilledema and computarized tomography of the head showed a cystic lesion (70X77 mm) in the left fronto-temporo-parietal area, midline shift and similar lesions scattered in the brain parenchyma. She was submitted to a left craniotomy with the diagnosis of cerebral cysticercosis and the major cyst (Cysticercus racemosus) and a small cortical cyst (10X10 mm) were removed to aliviate the increased intracraneal pressure and for histopathological examination. Thirteen days after surgery she was discharged without neurological deficits, except mild papilledema. One month later she was treated with praziquantel (50 mg/kg/day) during 21 days. The CSF examination was normal before the treatment started and showed a transient eosinophilic cellular reaction with positivation of the complement fixation test for cysticercosis while on treatment. The CT-Scan performed before the medical treatment revealed ventricular dilatation and several low density areas (10 to 40 mm) scattered in the cerebral parenchyma, including the operative site. CT-Scan performed three months later showed small low density areas only in the left cerebral hemisphere, including the operative site, calcification in the parenchyma, and slight dilatation of the left lateral ventricle. The clinical evolution was uneventful and the neurologic examination was normal three months later.

Forma tumoral de neurocisticercose: relato de caso

“…O diagnóstico diferencial no achado tomográfico de lesão cística cerebral inclui outras lesões parasitárias do SNC (equinococose, por exemplo), neoplasias primárias e metastáticas, tuberculomas, infecções fúngicas e lesões císticas benignas [16][17][18][19][20][21] .…”

“…Além disso, a forma hipertensiva da NC, na maioria dos casos, necessita de tratamento cirúr-gico, sob a forma de craniotomia descompressiva, abordagem microcirúrgica da lesão, procedimento estereotáxico ou derivação liquórica 4,11,[18][19][20][21][22] . Em vista da possibilidade de descompensação da HIC e de herniação transtentorial provocada por ampliação da reação inflamatória decorrente da degeneração do cisto, contra-indica-se o tratamento clínico específico com drogas cisticidas em pacientes apresentando cisto gigante com efeito de massa no SNC 4 .…”

Parenchymatous cerebral neurocysticercosis in a quadriplegic patient

“…15,16 As a consequence of the ®xation of the cysticercus larva in the brain, only small disturbances may be present during its life cycle. Generalised seizures are the common presentation of the parenchymal type and represents up to half of late-onset cases of epilepsy in endemic countries.…”

Surgical treatment of cerebral cysticercosis: long-term results and prognostic factors

“…Based on ventriculographic findings, we have sought to identify the site and type of obstruction 18 -that is, in patients with obstruction caused by free cysts who can benefit from cyst removal, 5,17,31,38,40,50,56 or in patients with obstruction caused by an inflammatory process in whom VP shunt surgery is considered the best treatment. 3,16,33,35,38 Generally CT scanning does not allow this differentiation because it does not reveal free intraventricular cysts, 19 which are only be suspected based on the morphological changes of the ventricles (rounding of the fourth or third ventricles or of portions of the lateral ventricles). Computerized tomography cisternography demonstrates cysts in the cisterns; additionally, when there is no obstruction of the ventricular system, it identifies intraventricular cysts (Figs.…”