Relevance of 3D magnetic resonance imaging sequences in diagnosing basal subarachnoid neurocysticercosis

Mezo, Roger Carrillo; García, Javier Lara; Arroyo, Mariana; Fleury, Agnès

doi:10.1016/j.actatropica.2015.08.017

Cited by 53 publications

(38 citation statements)

References 16 publications

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“…ParNCC has been extensively studied: Its main symptom is epilepsy [7, 8]; the parasite can be easily recognized by neuroradiological studies [9], and cysticidal treatment clearly improves most patients [10,11]. On the contrary, much less is known about extraparenchymal NCC (ExPNCC), occurring when cysticerci are lodged in the subarachnoid space of the basal cisterns, Sylvian fissure, and spinal medulla or in the ventricular system; such lack of information is probably due to a lower prevalence and the higher difficulties for its diagnosis [12, 13]. Although reviews and case reports of ExPNCC have been published [14–22], large series of patients are scarce.…”

Section: Introductionmentioning

confidence: 99%

Extraparenchymal neurocysticercosis: Demographic, clinicoradiological, and inflammatory features

et al. 2017

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BackgroundExtraparenchymal neurocysticercosis (ExPNCC), an infection caused by Taenia solium cysticerci that mainly occurs in the ventricular compartment (Ve) or the basal subarachnoid space (SAb), is more severe but less frequent and much less studied than parenchymal neurocysticercosis (ParNCC). Demographic, clinical, radiological, and lumbar cerebrospinal fluid features of patients affected by ExPNCC are herein described and compared with those of ParNCC patients.Methodology and principal findings429 patients with a confirmed diagnosis of neurocysticercosis, attending the Instituto Nacional de Neurología y Neurocirugía, a tertiary reference center in Mexico City, from 2000 through 2014, were included. Demographic information, signs and symptoms, radiological patterns, and lumbar cerebrospinal fluid (CSF) laboratory values were retrieved from medical records for all patients. Data were statistically analyzed to assess potential differences depending on cyst location and to determine the effects of age and sex on the disease presentation. In total, 238 ExPNCC and 191 ParNCC patients were included. With respect to parenchymal cysts, extraparenchymal parasites were diagnosed at an older age (P = 0.002), chiefly caused intracranial hypertension (P < 0.0001), were more frequently multiple and vesicular (P < 0.0001), and CSF from these patients showed higher protein concentration and cell count (P < 0.0001). SAb patients were diagnosed at an older age than Ve patients, and showed more frequently seizures, vesicular cysticerci, and higher CSF cellularity. Gender and age modulated some traits of the disease.ConclusionsThis study evidenced clear clinical, radiological, and inflammatory differences between ExPNCC and ParNCC, and between SAb and Ve patients, and demonstrated that parasite location determines different pathological entities.

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Section: Introductionmentioning

confidence: 99%

Extraparenchymal neurocysticercosis: Demographic, clinicoradiological, and inflammatory features

et al. 2017

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“…EP-NC is the most severe form of the disease and has high fatality, in addition to poor prognosis with severe sequelae. 3 Based on these results, it seems justifiable to perform a lumbar puncture to perform PCR of the CSF in order to confirm diagnosis of EP-NC and initiate appropriate treatment.…”

Section: Discussionmentioning

confidence: 99%

“…This may be partially due to the greater difficulty to accurately visualize a scolex in EP-NC on imaging, notwithstanding newer MRI techniques. 2,3 …”

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confidence: 99%

Validity of a PCR assay in CSF for the diagnosis of neurocysticercosis

Carpio

Campoverde

Romo

et al. 2017

Neurol Neuroimmunol Neuroinflamm

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Objective:To prospectively evaluate the validity of a PCR assay in CSF for the diagnosis of neurocysticercosis (NC).Methods:We conducted a multicenter, prospective case-control study, recruiting participants from 5 hospitals in Cuenca, Ecuador, from January 2015 to February 2016. Cases fulfilled validated diagnostic criteria for NC. For each case, a neurosurgical patient who did not fulfill the diagnostic criteria for NC was selected as a control. CT and MRI, as well as a CSF sample, were collected from both cases and controls. The diagnostic criteria to identify cases were used as a reference standard.Results:Overall, 36 case and 36 control participants were enrolled. PCR had a sensitivity of 72.2% (95% confidence interval [CI] 54.8%–85.8%) and a specificity of 100.0% (95% CI 90.3%–100.0%). For parenchymal NC, PCR had a sensitivity of 42.9% (95% CI 17.7%–71.1%), and for extraparenchymal NC, PCR had a sensitivity of 90.9% (95% CI 70.8%–98.9%).Conclusions:This study demonstrated the usefulness of this PCR assay in CSF for the diagnosis of NC. PCR may be particularly helpful for diagnosing extraparenchymal NC when neuroimaging techniques have failed.Classification of evidence:This study provides Class III evidence that CSF PCR can accurately identify patients with extraparenchymal NC.

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“…However, small cysts in early stages of development often escaped detection. Recently, high-resolution magnetic resonance cisternography sequences have improved the identification of such cysts [15, 19]. …”

Section: Discussionmentioning

confidence: 99%

“…CT provides useful information on the stage of parenchymal parasite development; however, it lacks accuracy for the identification of cysts in the CSF compartments because CSF and cyst fluid show similar attenuation on X-rays. MRI enables better visualization of cysts within the subarachnoid space and ventricles [18]; particularly new MRI sequences with improved sensitivities allow earlier diagnosis [19]. …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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Extraparenchymal neurocysticercosis has an aggressive course because cysts in the cerebrospinal fluid compartments induce acute inflammatory reactions. The relationships between symptoms, imaging findings, lesion type and location remain poorly understood. In this retrospective clinical records-based study, we describe the clinical symptoms, magnetic resonance imaging features, and cyst distribution in the CSF compartments of 36 patients with extraparenchymal neurocysticercosis. Patients were recruited between 1995 and 2010 and median follow up was 38 months. During all the follow up time we found that 75% (27/36) of the patients had symptoms related to raised intracranial pressure sometime, 72.2% (26/36) cysticercotic meningitis, 61.1% (22/36) seizures, and 50.0% (18/36) headaches unrelated to intracranial pressure. Regarding lesion types, 77.8% (28/36) of patients presented with grape-like cysts, 22.2% (8/36) giant cysts, and 61.1% (22/36) contrast-enhancing lesions. Hydrocephalus occurred in 72.2% (26/36) of patients during the follow-up period. All patients had cysts in the subarachnoid space and 41.7% (15/36) had at least one cyst in some ventricle. Cysts were predominantly located in the posterior fossa (31 patients) and supratentorial basal cisterns (19 patients). The fourth ventricle was the main compromised ventricle (10 patients). Spinal cysts were more frequent than previously reported (11.1%, 4/36). Our findings are useful for both diagnosis and treatment selection in patients with neurocysticercosis.

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Relevance of 3D magnetic resonance imaging sequences in diagnosing basal subarachnoid neurocysticercosis

Cited by 53 publications

References 16 publications

Extraparenchymal neurocysticercosis: Demographic, clinicoradiological, and inflammatory features

Extraparenchymal neurocysticercosis: Demographic, clinicoradiological, and inflammatory features

Validity of a PCR assay in CSF for the diagnosis of neurocysticercosis

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

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