Abstract:The study is based on 371 cerebrospinal fluid (CSF) samples and 324 serum samples from 40 patients with neurocysticercosis (NC) submitted to treatment with praziquantel. The aim of the study is a critical evaluation on humoral immunity in CSF NC syndrome. The analysis of NC patients at diagnosis and in the follow-up period was performed considering three connected criteria: the clinical one, the CSF examination and the computed tomography. For the study of CSF and serum samples a systematization of collection … Show more
“…A importância do LCR no estabelecimento do diagnóstico da NC é reconhecida universalmente, tendo sido considerado, até o advento da TC do crânio, como o cri-tério mais fidedigno. O conceito de síndrome do LCR na NC, introduzido por Lange 2 <> em 1940, compreendendo a eosinofilorraquia e a positividade da reação de Weinberg, persiste até o presente momento 1, 6,9,10,22,24,[38][39][40][41][42][43][44]52,[54][55][56]63.…”
Section: A Ocorrência De Crises Epilépticas Constituiu-se Na Primeiraunclassified
“…A relação entre as diferentes alterações constatadas na TC e no LCR é raramente enfocada na literatura e, mesmo assim, com discrepância de opiniões: Schenone^o e Sotelo et al 53 , analisando material constituído exclusivamente por lesões cisticas na TC, constataram a presença de pleocitose em 90% e 60%, respectivamente; Livramento 22 , por outro lado, referiu não haver relação entre os aspectos clínicotomográficos e os do LCR. Verificamos, em nosso material, que o cisto no interior do parênquima esteve relacionado com a presença de anormalidades no LCR (90,9%), destacando-se a pleocitose (81,8%) e a positividade da reação de Weinberg (81,8%).…”
Section: A Ocorrência De Crises Epilépticas Constituiu-se Na Primeiraunclassified
Neurocysticercosis is a serious public health problem in our midst, which accounted for 7.3% of the hospital admissions and 2.7% of all cases of the out patient clinic attendance of the Discipline of Neurology of the School of Medicine--Ribeirão Preto, São Paulo University, from 1979 to 1986. A total of 151 patients with a minimum follow-up of 6 months were selected for the present study including clinical and laboratory evolution, a topic which is rarely considered in the literature. The onset of the disease was characterized by: epileptic seizures in 82 patients (54.3%), increased intracranial pressure (ICP) in 40 (26.5%), meningitis in 21 (13.9%), headache in the absence of increased ICP or meningitic signs in 7 (4.6%), and spinal cord syndrome in 1 (0.6%). In the group with the epileptic form, 36.6% of the patients later developed other neurological syndromes, such as cysticercotic meningitis, mental disorders and increased ICP after a 6 to 7 years interval. In the group with the hypertensive form, 55% of the patients developed other manifestations during the period of evolution, especially meningitis and epileptic seizures, after a significantly shorter interval than for the epileptic form. In the meningitic form, 19% of the patients showed a recurrence of the syndrome after a mean interval of 10.7 weeks: an additional 66.6% developed a combination with other syndromes, especially increased ICP and epileptic seizures. The death rate was 7.9%, the main cause being increased ICP (83.3%). When the abnormalities of the complementary tests were investigated in the various forms of clinical presentation in terms of their predictive value it was concluded that, in the epileptic form, the presence of cysts in CT scan and/or abnormalities in CSF indicates a greater risk of developing other neurologic syndromes. No significant differences in the patterns of abnormalities of these investigations were detected in the remaining clinical forms. Most cystic lesions detected by CT scan (90.9%) were associated with CSF abnormalities, especially pleocytosis and positive complement fixation test. Conversely, this proportion was only 26% in patients with calcifications.
“…A importância do LCR no estabelecimento do diagnóstico da NC é reconhecida universalmente, tendo sido considerado, até o advento da TC do crânio, como o cri-tério mais fidedigno. O conceito de síndrome do LCR na NC, introduzido por Lange 2 <> em 1940, compreendendo a eosinofilorraquia e a positividade da reação de Weinberg, persiste até o presente momento 1, 6,9,10,22,24,[38][39][40][41][42][43][44]52,[54][55][56]63.…”
Section: A Ocorrência De Crises Epilépticas Constituiu-se Na Primeiraunclassified
“…A relação entre as diferentes alterações constatadas na TC e no LCR é raramente enfocada na literatura e, mesmo assim, com discrepância de opiniões: Schenone^o e Sotelo et al 53 , analisando material constituído exclusivamente por lesões cisticas na TC, constataram a presença de pleocitose em 90% e 60%, respectivamente; Livramento 22 , por outro lado, referiu não haver relação entre os aspectos clínicotomográficos e os do LCR. Verificamos, em nosso material, que o cisto no interior do parênquima esteve relacionado com a presença de anormalidades no LCR (90,9%), destacando-se a pleocitose (81,8%) e a positividade da reação de Weinberg (81,8%).…”
Section: A Ocorrência De Crises Epilépticas Constituiu-se Na Primeiraunclassified
Neurocysticercosis is a serious public health problem in our midst, which accounted for 7.3% of the hospital admissions and 2.7% of all cases of the out patient clinic attendance of the Discipline of Neurology of the School of Medicine--Ribeirão Preto, São Paulo University, from 1979 to 1986. A total of 151 patients with a minimum follow-up of 6 months were selected for the present study including clinical and laboratory evolution, a topic which is rarely considered in the literature. The onset of the disease was characterized by: epileptic seizures in 82 patients (54.3%), increased intracranial pressure (ICP) in 40 (26.5%), meningitis in 21 (13.9%), headache in the absence of increased ICP or meningitic signs in 7 (4.6%), and spinal cord syndrome in 1 (0.6%). In the group with the epileptic form, 36.6% of the patients later developed other neurological syndromes, such as cysticercotic meningitis, mental disorders and increased ICP after a 6 to 7 years interval. In the group with the hypertensive form, 55% of the patients developed other manifestations during the period of evolution, especially meningitis and epileptic seizures, after a significantly shorter interval than for the epileptic form. In the meningitic form, 19% of the patients showed a recurrence of the syndrome after a mean interval of 10.7 weeks: an additional 66.6% developed a combination with other syndromes, especially increased ICP and epileptic seizures. The death rate was 7.9%, the main cause being increased ICP (83.3%). When the abnormalities of the complementary tests were investigated in the various forms of clinical presentation in terms of their predictive value it was concluded that, in the epileptic form, the presence of cysts in CT scan and/or abnormalities in CSF indicates a greater risk of developing other neurologic syndromes. No significant differences in the patterns of abnormalities of these investigations were detected in the remaining clinical forms. Most cystic lesions detected by CT scan (90.9%) were associated with CSF abnormalities, especially pleocytosis and positive complement fixation test. Conversely, this proportion was only 26% in patients with calcifications.
“…O exame de LCR é um importante teste na avaliação e acompanhamento de pacientes com suspeita de NC embora possa, em alguns pacientes, apresentar-se normal ou com alterações insuficientes para o diagnóstico da doença (LIVRAMENTO et al, 1987). As alterações encontradas no LCR são pleocitose linfomononuclear, eosinofilorraquia, e presença de anticorpos específicos (LANGE, 1940).…”
100% e mesmo em diferentes prováveis prevalências (0,1; 0,5; 1,0 e 5,0%) o VPP e o valor preditivo negativo (VPN) foram fixados também em 100%. A repetitividade das leituras do teste expressa em coeficiente de variação apresentou-se entre 16 e 18%. O teste ELISA-Tcra não demonstrou o mesmo desempenho, a especificidade foi calculada em 96,3% e o VPP variou entre 2,6 a 59,3% para prevalências de 0,1 a 5,0%; quanto à sensibilidade e VPN houve similaridade entre os resultados. O ELISA-Tso apresentou resultados ainda menos expressivos, a especificidade foi calculada em 95,7% e o VPP variou entre 2,3 a 55% para as prevalências de 0,1 a 5,0%; essa redução na especificidade se dá pelo aumento do número de resultados falso-positivos no teste em conseqüência da expressão de proteínas de alto peso molecular. Através dos parâmetros avaliados fica notório o desempenho promissor do teste ELISA-18/14 na pesquisa de anticorpos anti-cisticercos de Taenia solium em inquéritos sorológicos da população geral.
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