Reduced Diffusion in Neurocysticercosis: Circumstances of Appearance and Possible Natural History Implications

Santos, Germana Titoneli dos; Leite, Cláudia C.; Machado, L. R.; McKinney, Alexander M.; Lucato, Leandro Tavares

doi:10.3174/ajnr.a3198

Cited by 29 publications

(17 citation statements)

References 29 publications

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“…Once the oncosphere has passed into the parenchyma, it grows and evolves through vesicular, colloidal, granular-nodular, and calcified phases. In the vesicular phase, the host tends to show immune tolerance and in most cases there is no surrounding parenchymal reaction; the larva lives inside a translucent liquid-filled cystic structure surrounded by a thin membrane, where it can remain viable from a few months to several years 10 . Figure depicts circumscribed, rounded, hypodense areas, varying in size and number, without enhancement by contrast media.…”

Section: Distinguishing Between Seizures and Epilepsy As They Relate mentioning

confidence: 99%

“…Although these pathological changes are responsible for clinical manifestations, such as seizure and headache, they may also be completely asymptomatic. Finally, when the cyst dies, it may disappear or become an inactive calcified nodule of homogenous high density on CT, or low intensity on proton-weighted MRI 9,10 . A classification based on the viability and location of the parasite in the CNS has been proposed: active, when the parasite is alive; transitional or degenerative, if it is in the colloidal and granular-nodular phase; or inactive, if there is evidence of its death 11 .…”

Section: Distinguishing Between Seizures and Epilepsy As They Relate mentioning

confidence: 99%

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The relationship between neurocysticercosis and epilepsy: an endless debate

Carpio

Romo

2014

Arq. Neuro-Psiquiatr.

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Neurocysticercosis (NC), or cerebral infection with Taenia solium, is an important public health problem worldwide. Among the neurological sequelae of NC, seizures have been described as the most common symptom. Acute symptomatic seizures often result from degeneration of a viable cyst; however, not all of these patients with acute or provoked seizures will develop epilepsy (i.e., recurrent unprovoked seizures). Because of the high prevalence of epilepsy and NC, a causal, as well as incidental relationship between the two may exist. The epileptogenicity of calcified cysts as well as the potential association between NC and hippocampal sclerosis necessitates future research. Antihelminthic treatment of NC results in disappearance of viable cysts in about one-third of patients with parenchymal disease, but a reduction in seizure recurrence has not been demonstrated in randomized controlled trials. Prevention is critical to reduce the burden of seizure and epilepsy related to NC.Keywords: cysticercosis, Taenia solium, seizure, parasitic. RESUMOA neurocisticercose (NC) ou infecção cerebral pela Taenia solium é importante problema de saúde pública em todo o mundo. Entre as sequelas neurológicas da NC, as crises convulsivas têm sido descritas como os sintomas mais frequentes. Crises convulsivas sintomáticas agudas resultam, muitas vezes, da degeneração de cistos viáveis; entretanto, nem todos os pacientes com NC e crises agudas ou provocadas desenvolvem epilepsia (i.e., crises recorrentes não provocadas). Pode haver uma relação entre epilepsia e NC, causal ou incidental, devido à alta prevalência de ambas. O potencial epileptogênico dos cistos calcificados assim como a possível associação entre NC e esclerose hipocampal ainda necessitam de futuras pesquisas. O tratamento anti-helmíntico da NC resulta no desaparecimento de cistos viáveis em cerca de 1/3 dos pacientes com a doença parenquimatosa, mas não foi demonstrada redução nas taxas de recorrência das crises convulsivas em estudos randomizados controlados. A prevenção é crítica para reduzir o contingente de crises convulsivas e epilepsia relacionadas à NC.

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Section: Distinguishing Between Seizures and Epilepsy As They Relate mentioning

confidence: 99%

Section: Distinguishing Between Seizures and Epilepsy As They Relate mentioning

confidence: 99%

The relationship between neurocysticercosis and epilepsy: an endless debate

Carpio

Romo

2014

Arq. Neuro-Psiquiatr.

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“…And it disappears in the 'early' granular nodular stage when the contents changes from viscous fluid to solid material. The overall role of DWI comes in these stages by helping in the identification of the scolex [35]. Diffusion tensor imaging (DTI) is not used routinely in the diagnosis of NCC.…”

Section: Role Of Advanced Mri Sequences Dwi/dtimentioning

confidence: 99%

A comprehensive review of imaging findings in human cysticercosis

et al. 2016

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“…MRI is the best test for definition of the cyst stage in their evolution in the brain on T1, T2, FLAIR sequences, including the inflammatory aspects when using enhanced images with gadolinium infusion ( Figures 3A, B and C) 29 although not as accurate in detection of calcifications. Diffusion weighted images were demonstrated as better defining the scolex and increasing the confidence for the NCC diagnosis by MRI 30 . A recent review on NCC showed that MRI findings are better predictive for the stage of the cysts and diffusion-weighted images and apparent diffusion coefficient maps allowing better demonstration of the cysticerci in their colloidal phase.…”

Section: The Quest For the Neuroimagingmentioning

confidence: 99%

“…With cerebral cyst degeneration there is a contrast enhancement of the lesion surrounded by edema on CT as well as high signal images on MRI T2 sequences and gadolinium enhancement on T1 images supposedly due to inflammatory reactions 4,5 . Epilepsy, in general grounds, is defined by unprovoked seizures in more than one occasion 6 and usually correlates with the most probable condition directly involved on its development.…”

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confidence: 99%

Neurocysticercosis, familial cerebral cavernomas and intracranial calcifications: differential diagnosis for adequate management

Gasparetto

Alves-Leon

Domingues

et al. 2016

Arq. Neuro-Psiquiatr.

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Neurocysticercosis (NCC) is an endemic disease and important public health problem in some areas of the World and epilepsy is the most common neurological manifestation. Multiple intracranial lesions, commonly calcified, are seen on cranial computed tomography (CT) in the chronic phase of the disease and considered one of the diagnostic criteria of the diagnosis. Magnetic resonance imaging (MRI) is the test that better depicts the different stages of the intracranial cysts but does not show clearly calcified lesions. Cerebral cavernous malformations (CCM), also known as cerebral cavernomas, are frequent vascular malformations of the brain, better demonstrated by MRI and have also epilepsy as the main form of clinical presentation. When occurring in the familial form, cerebral cavernomas typically present with multiple lesions throughout the brain and, very often, with foci of calcifications in the lesions when submitted to the CT imaging. In the countries, and geographic areas, where NCC is established as an endemic health problem and neuroimaging screening is done by CT scan, it will be important to consider the differential diagnosis between the two diseases due to the differences in adequate management.

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Reduced Diffusion in Neurocysticercosis: Circumstances of Appearance and Possible Natural History Implications

Abstract: BACKGROUND AND PURPOSE:Few studies discuss DWI findings in patients with NCC, and their conclusions are variable and contradictory. The aim of our study was to describe DWI findings of a cohort of patients with NCC, emphasizing the frequency of reduced diffusion.

Cited by 29 publications

References 29 publications

The relationship between neurocysticercosis and epilepsy: an endless debate

The relationship between neurocysticercosis and epilepsy: an endless debate

A comprehensive review of imaging findings in human cysticercosis

Neurocysticercosis, familial cerebral cavernomas and intracranial calcifications: differential diagnosis for adequate management

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