Lacunar Syndrome due to Neurocysticercosis

Background and Purpose:In 1985 we initiated a protocol for examining the relationship between cerebral cysticercosis and stroke.Methods: In 420 stroke patients admitted to our department, our standard protocol of tests included blood tests, cardiac investigations, angiography, and immunologic cerebrospinal fluid measures. We assessed the following possible risk factors: arterial hypertension, diabetes, cardiopathy, high levels of cholesterol and triglycerides, smoking, alcohol abuse, and cerebral cysticercosis.Results: Of the 420 patients with stroke, we found cerebral cysticercosis in 31, five of whom were >65 years of age and 26 of whom were <65 years. We determined that cerebral cysticercosis was the only possible risk factor for stroke in one of the five older patients and 15 of the 26 younger and middle-aged patients. Cortical infarctions were found in five of the 31 patients, with cerebral cysticercosis and lacunar infarctions in nine of these patients. One patient had intracystic hemorrhage. In 16 cases, neurological deficit was related to single or multiple cysts, colloids, granulomas, diffuse lesions, or pericystic edema. All patients with cerebral cysticercosis quickly recovered from their neurological deficit, except one who had a hemorrhagic cyst and died and another who remained disabled.Conclusions: We established that, in patients with neurocysticercosis, occlusion of the small cortical or penetrating vessels at the base of the brain caused by arteriopathy was the most common mechanism of the stroke. Moreover, there is a probable association between cerebral cysticercosis and the susceptibility to stroke, particularly among young and middle-aged patients. (Stroke 1992;23:224-228)

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“…30 This vascular compromise can lead in some cases to the complete occlusion of a blood vessel, with subsequent infarction 20 ( Figure 2). …”

Section: Discussionmentioning

confidence: 99%

Cerebral cysticercosis and stroke.

Alarcón

Hidalgo

Moncayo

et al. 1992

Stroke

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“…These attribute stroke to thrombosis of superficial cortical vessels by chronic meningitis, 11 infarction of small arterial branches secondary to neurocysticercosis-induced vasculitis, 8 and lacunar infarcts resulting from occlusion of terminal vessels affected by endarteritis secondary to neurocysticercosis. 9 Neurocysticercosis was reported to be the cause of a mycotic aneurysm of the MCA. 10 There are reports of angiography revealing multiple occlusions of branches of the MCA 13 and MCA trunk 5 leading to infarction and two reports of angiograms revealing occlusion of the supraclinoid internal carotid artery 612 ; one case was secondary to adherent cysticercosis cysts at craniotomy.…”

Section: Panel B: Cutoff Of Left ML Segment Is Seen On Ap View (Arrowmentioning

confidence: 99%

Bilateral middle cerebral artery occlusions in neurocysticercosis.

terPenning

Litchman

Heier

1992

Stroke

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Background: Bilateral hemispheric strokes in a young adult are very rare. We describe a case of neurocysticercosis in a young male with bilateral middle cerebral artery occlusions.Case Description: Axial tomographic imaging revealed lesions compatible with cysticerci adjacent to each middle cerebral artery initial segment, and occlusion of both arteries at that level was demonstrated by angiography. Extensive medical workup disclosed no other risk factors for stroke.Conclusions: Neurocysticercosis should be considered in the differential diagnosis of stroke in a young patient. (Stroke 1992;23:280-283)

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“…The cause(s) of "lacunar syndromes" have strayed so far from stroke as to include cysticercosis. 28 Landau 29 recently wrote "the clinical descriptions of lesions identify neither specific etiologies nor locations any more specific than those of well-known anatomic tracts and centers. "…”

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The fallacy of the lacune hypothesis.

Millikan

Futrell

1990

Stroke

153

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We review the definition, pathogenesis, natural history, and prognosis and describe the first experimental model of lacunes. Defined pathologically or radiologically, lacunes are small cerebral infarcts which become cystic and are caused by occlusion of small arteries. The clinical definition of lacune is confused. The word "lacune" means a small stroke. While the immediate mortality rate from a small stroke is low, many patients are unable to return to work and the long-term prognosis is guarded. Photochemical damage to the carotid artery of rats produces microemboli to the brain, resulting in cavitary lesions resembling lacunes in humans. The "lacune hypothesis" is a fallacy because small cerebral infarcts are not caused solely by a combination of hypertension and small vessel disease, and the various "lacunar syndromes" are simply small strokes which should be investigated as such. (Stroke 1990;21:1251-1257) T he "lacune hypothesis" states that lacunes are caused by a combination of hypertension and characteristic vascular lesions involving single perforating brain arteries.

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Lacunar Syndrome due to Neurocysticercosis

Cited by 77 publications

References 27 publications

Cerebral cysticercosis and stroke.

Cerebral cysticercosis and stroke.

Bilateral middle cerebral artery occlusions in neurocysticercosis.

The fallacy of the lacune hypothesis.

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