Forma edematosa da neurocisticercose: registro de 4 casos

Braga, Fernando Menezes; Ferraz, Fernando Antônio Patriani

doi:10.1590/s0004-282x1981000400009

Cited by 9 publications

(7 citation statements)

References 11 publications

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“…The epilepsy is characterised by more than one type of crisis and a difficult control of the seizures 12,13 , and could be the first manifestation of hypertensive hydrocephalus, diffuse cerebral oedema, or the effect mass of giant cysts. ICH is a frequent and immediate consequence of the inflammatory reaction, as in the subarachnoid space 14,15 , as in the parenchyma 16,17 , or as a direct response to the physical presence of parasites. Psychic disturbances in neurocysticercosis, could float from mild symptoms like apathy, cognitive disturbances, alterations in the humour and memory, to more severe psychiatric pictures as dementia, depression and schizophrenia [18][19][20][21][22] .…”

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confidence: 99%

Fourth ventricle computed tomography indexes: standardisation and characteristics in neurocysticercosis

Agapejev

2002

Arq. Neuro-Psiquiatr.

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-Objectives: to propose standardisation of fourth ventricle dimensions and to study its characteristics in neurocysticercosis. Method: a control group (CG) constituted by 114 individuals with normal CT, and 80 patients with neurocysticercosis composed the group with neurocysticercosis (GN). Measures of the inner cranial diameter (Cr), fronto-polar distance between both lateral ventricles (FP), antero-posterior (AP) and latero-lateral (LL) fourth ventricle width based the standardisation of six indexes. Results: AP/Cr, AP/LL and AP/ FP were the more discriminative indexes, presenting in CG the mean values of 0.063, 0.267 and 0.582, respectively. The indexes in GN had values statistically higher than in CG. From GN, 51patients had increased indexes values above 2 standard deviation of the CG mean. AP/Ll was > 1 in 95% of patients with ventricular shunting and in 88% with depression. It also occurred in 73% patients with satisfactory follow-up and in everybody who died. Conclusion: AP/Cr, AP/LL and AP/FP may represent fourth ventricle dimensions.KEY WORDS: fourth ventricle, indexes, computed tomography, standardisation, neurocysticercosis. Índices do IV ventrículo em tomografia computadorizada de crânio: padronização e características na neurocisticercoseRESUMO -Objetivos: propor padrão de normalidade das dimensões do IV ventrículo e estudar suas características em neurocisticercose. Método: em um grupo controle (GC) constituído de 114 indivíduos com tomografias normais e em outro grupo composto de 80 doentes com neurocisticercose (GN), mediram-se a distância fronto-polar de ventrículos laterais (FP) e os diâmetros craniano interno (Cr), ântero-posterior (AP) e látero-lateral (LL) do IV o ventrículo para a padronização de seis índices. Resultados: AP/Cr, AP/LL e AP/FP foram os índices mais discriminatórios e apresentaram, em GC, valores médios de 0,063, 0,267 e 0,582, respectivamente. Em GN os valores foram estatisticamente superiores a GC. Selecionaram-se 51 doentes do GN com índices > 2 desvios-padrão da média em GC. Neles, AP/Ll foi > 1 em 95% doentes com derivação liquórica e em 88% com depressão, ocorrendo em 73% com evolução satisfatória e todos que faleceram. Conclusão: AP/Cr, AP/LL e, principalmente, AP/FP são representativos das dimensões do IV ventrículo.

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confidence: 99%

Fourth ventricle computed tomography indexes: standardisation and characteristics in neurocysticercosis

Agapejev

2002

Arq. Neuro-Psiquiatr.

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“…14,36,55 Treatment of this form is primarily medical to reduce the intracranial hypertension by administering osmotic diuretics, steroid agents, and by performing CSF lumbar puncture, and it is effective in most cases. 8,13 In the past, decompressive craniectomy was recommended 8 in these patients to avoid visual loss due to papilledema, but its results were only transient. 55 In our opinion decompressive craniotomy is only rarely indicated and should be performed in extreme situations in an attempt to control intracranial hypertension.…”

Section: Forms Progressing To Intracranial Hypertensionmentioning

confidence: 99%

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

Colli¹,

Carlotti²,

Assirati³

et al. 2002

FOC

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Object Cysticercosis is the most frequent parasitosis of the central nervous system. Although anticysticercal drugs have proven efficient in some cases, many patients with NCC require palliative, occasionally curative, surgical procedures. The authors analyzed the data and prognostic factors obtained during the follow-up period (range 1–255 months, median 38 months) in 160 patients with cerebral cysticercosis who underwent surgical treatment. Methods Different surgical approaches were indicated to control increased intracranial pressure (ICP) in most patients, and some patients had undergone decompressive surgery for local brain lesions. Most patients required more than one surgical procedure. Statistical analysis was performed using the Fisher exact, the log-rank, and the Kruskall–Wallis tests. Survival curves were calculated according the Kaplan–Meier method. The removal of a giant cyst from the parenchyma or cisterns for relief of increased ICP and for chiasm/optic nerve decompression improved most symptoms in patients. The removal of ventricular cysts was effective in the control of increased ICP in most patients. Patients with a ventricular cyst and ependymitis/arachnoiditis required placement of a ventriculoperitoneal (VP) shunt after the cyst was removed. This therapy effectively controlled increased ICP. Patients younger than 40 years of age at the time of treatment and male patients had worse outcomes. The outcome in patients who underwent VP shunt surgery or shunt surgery combined with reservoir implantation was worse than that in those who underwent cyst removal alone. Shunt-related infection was the most frequent complication, and the global mortality rate during the follow-up period was 21.2%. Although both complications were more frequent in the first 2 postoperative years, they occurred at any time. Conclusions Long-term prognosis in patients with cerebral cysticercosis who required surgery was not good. Cysts located in the basal cisterns and patient age younger than 40 years were poor prognostic factors.

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“…Ressaltando a pouca ênfase que tem sido dada à manifestação de hipertensão intracraniana benigna (HICb), como uma das formas de apresentação clínica da NCC, as formas edematosas, ou encefalíticas [11][12][13][14][15][16][17][18][19] , que ocorrem em 9-43% dos pacientes, têm sido relatadas como uma das apresentações da forma hipertensiva. Na NCC, o edema pode ser a consequência não só da presença de cistos parenquimatosos, mas também constituir uma resposta anormal e global do encéfalo à pura presença de antígenos, independente da existência de formas calcificadas.…”

Section: Comentáriosunclassified

“…Na NCC, o edema pode ser a consequência não só da presença de cistos parenquimatosos, mas também constituir uma resposta anormal e global do encéfalo à pura presença de antígenos, independente da existência de formas calcificadas. O que parece é que, por algum motivo ainda não totalmente esclarecido, o sexo feminino mostra maior predisposição à manifestação de uma resposta inflamatória mais difusa que localizada 12,16,20,21 ou, como sugere o estudo em discussão, sem a presença demonstrável de parasitas vivos no parênquima do SNC. Ou seja, a simples presença do parasita vivo não parece ser a única responsável pela resposta imunológica do hospedeiro.…”

Section: Comentáriosunclassified

Edema cerebral crônico na neurocisticercose

Agapejev

Yela²,

Gomes³

1998

Arq. Neuro-Psiquiatr.

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RESUMO -Neste estudo retrospectivo, relatam-se as características clínicas do edema cerebral crônico (ECCr) em 34 pacientes com neurocisticercose (NCC), que apresentavam edema cerebral difuso, à tomografia computadorizada (TC), como característica comum. Todos foram tratados com dextroclorofeniramina e, 32 deles, com albendazol. O ECCr predominou no sexo feminino (73,5%) na faixa etária dos 11 -40 anos (92,3%). A cefaléia ocorreu em 94,1% dos pacientes, náuseas/vômitos em 47,1%, crises epilépticas em 41,1% e distúrbios psíquicos em 38,2%. A hiperreflexia ocorreu em 82,3% e o papiledema em 58,8% e o exame neurológico normal em 11,8%. Na TC, o edema esteve associado a calcificações em 61,8% dos casos. As pressões liquóricas foram mais elevadas (p< 0,05) antes do tratamento. Atualmente, estão assintomáticos, ou com melhora clínica, 79,4% dos pacientes (57,1% deles sem medicação). Discute-se a possibilidade do ECCr, na NCC, ser uma manifestação antigênica, sem a presença concomitante de cistos parasitários, e poder representar mais uma condição clínica associada à hipertensão intracraniana benigna.PALAVRAS-CHAVE: neurocisticercose, edema cerebral crônico, hipertensão intracraniana benigna, tratamento. Chronic brain oedema in neurocysticercosisABSTRACT -In a retrospective study, we report the clinical characteristics of chronic brain oedema (CBO) in 34 patients with neurocysticercosis (NCC) who presented diffuse brain oedema upon computed tomography (CT) as a common point. All patients received dextrochlorpheniramine, and, 94.1% of them also albendazole. A predominance of females (73.5%) aged 11-40 years (92.3%) was seen. Headache occurred in 94.1% of patients, nausea/vomiting in 47.1%, epileptic manifestations in 41.1% and psychiatric disorders in 38.2%. Hyperreflexia was obtained in 82.3% of patients, papilloedema in 58.8% and normal neurological examination in 11.8%. The CT scan of the brain showed an association of oedema with calcifications in 61.8% of cases. The cerebrospinal fluid (CSF) pressure was higher before than after treatment (p < 0.05). At the last visit, 79.4% of patients were currently asymptomatic (57.1% of them without medication). It is pointed out that CBO may be an antigenic manifestation in NCC without the concomitant presence of parasitic cysts and may represent an additional clinical condition associated with benign intracranial hypertension.KEY WORDS: neurocysticercosis, brain oedema, benign intracranial hypertension, treatment.A neurocisticercose (NCC) é a doença parasitária mais comum do sistema nervoso central (SNC), causada pela forma larvária da Taenia solium. Os sinais e sintomas decorrentes dessa infecção dependem, fundamentalmente, da resposta imunológica do hospedeiro 1-3 e, como resultado, mostram variabilidade em suas exteriorizações clínicas.As manifestações desta neuroparasitose ocorrem através de múltiplas facetas, variando desde simples enxaqueca 4 aos mais graves sinais e sintomas de hipertensão intracraniana 5 , passando por

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Forma edematosa da neurocisticercose: registro de 4 casos

Cited by 9 publications

References 11 publications

Fourth ventricle computed tomography indexes: standardisation and characteristics in neurocysticercosis

Fourth ventricle computed tomography indexes: standardisation and characteristics in neurocysticercosis

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

Edema cerebral crônico na neurocisticercose

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