脑囊虫病诊断方法的探讨

为进一步探讨脑囊虫病的诊断方法,对43例具有中枢神经系统症状和体征的病人进行了脑部CT、血清和CSF囊虫抗体检查（ELISA法）,32例CT无典型脑囊虫病改变的患者做了脑MRI检查。结果11例（25．6％）CT表现为多发圆形低密度灶,部分间有点状钙化,为脑囊虫病的典型改变,余32例改变不典型或无异常改变。血清囊虫抗体阳性37例（86．0％）,CSF囊虫抗体阳性32例（74．0％）。27例（84．4％）脑MRI可见典型脑囊虫病改变,5例为非特异性改变。认为脑囊虫病的诊断应结合临床表现、免疫学检查结果和影像学改变综合分析,MRI对脑囊虫病的诊断价值优于CT。     

高颅压型脑囊虫病术后服吡喹酮的组织病理学研究

目的从组织病理学方面研究手术并服吡喹酮治疗高颅压型脑囊虫病的优越性。方法对从1984年-2002年收治的230例高颅压型脑囊虫病人进行手术并手术后服吡喹酮治疗,对摘出囊虫进行病理观察。结果随访6个月,脑室型囊虫术后复查CT示:脑室系统对称性扩大,梗阻脑积水影像消失,皮肌内囊虫阴影消失90%以上者92例,血常规及血生化检查正常,癫癎发作减少75%以上,高颅压症状完全消失。总有效率96.7%,死亡率3.3%。结论术后服吡喹酮是治疗高颅压型脑囊虫病较为有效的方法。     

高颅压型脑囊虫病术后服吡喹酮的组织病理学研究

目的 从病理组织学厅面研究手术并服毗喹酮治疗高颅压型脑囊虫病的优越性。方法 对1984-2002年收治的230例高颅胝型腑囊虫病人进行手术并服吡喹酮治疗，摘出囊虫后进行病理观察。结果 随访89例6个月，癫痫发作减少75％以上；高颅压症状完全消失；腰穿脑脊液压力正常；血常规及血生化检查正常；复查CT示脑室系统对称性扩大及梗阻性脑积水影像消失，皮肌内囊虫消失90％者72例。结论 术后服用吡喹酮是治疗高颅压型脑囊虫病较为有效的方法。     

儿童第四脑室肿瘤显微外科治疗策略

目的探讨儿童第四脑室肿瘤的生物学特点及显微外科治疗策略。方法 1998年至2009年收治的儿童第四脑室肿瘤患者45例,对其病理特点、临床表现、影像学变化、手术操作和预后等方面进行回顾性分析。结果肿瘤全切除36例,次全切除及大部切除9例;术后病理示髓母细胞瘤28例,室管膜瘤14例,星形细胞瘤3例;术后临床症状好转32例,无改善10例,恶化2例,1例患者死于严重脑干水肿;术后复查有4例因脑积水行脑室-腹腔分流术。结论儿童第四脑室肿瘤首发症状多种多样,MRI对于诊断与手术有重要的意义,采取合适的显微神经外科策略是提高手术疗效的关键。     

脑囊尾蚴病神经影像学表现与循环抗原相关性研究

目的探讨脑囊虫病血清循环抗原（CAg）与神经影像学（CT、MRI）的关系。方法根据诊断脑囊虫病的四个标准,对确诊的36例脑囊虫病病人行CAg定量测定及神经影像学检查并分期。结果根据神经影像学检查,36例脑囊虫病人在活虫期、变性死亡早期、变性死亡后期及钙化期之间的CAg水平有显著性差异（P〈0.01）。相关性分析表明血清中CAg的含量与脑囊虫病的神经影像学表现具有正相关性,其相关系数为0.871。结论（1）脑囊虫病人循环抗原与神经影像学（CT、MRI）表现具有相关性;（2）血清循环抗原的检查可用于对脑囊虫病的早期诊断和指导临床治疗。     

神经元性上皮瘤的MRI及病理与临床

神经元性上皮瘤为胚胎期的神经细胞分化不良演变而来 ,多见于儿童 ,临床上极为罕见 ,近来收治一例神经元性上皮瘤患者 ,并经病理证实 ,现将其 MRI临床及病理特征报告如下 :男性 ,5岁半 ,因阵发性头痛两年余 ,双下肢无力 60天于 1 998年 7月 2 2日住院。1 996年 4月突发头痛伴呕吐 ,非喷射状 ,无抽搐 ,1 0天后行 MRI怀疑为脑囊虫病并脑室扩大 ,脑积水 (图 1见封 4 ) ,但多次查大便均未找到囊虫或虫卵 ,囊虫血清学反应阴性 ,经脑室腹腔内引流术后头痛缓解 ,MRI示脑室恢复正常 ,住院期间曾服过皮质类固醇月余 ,并服用驱虫药治疗 ,1 998年 5…     

第四脑室囊虫病的诊断和治疗(附81例报告)

第四脑室囊虫堵塞脑室通路,引起阻塞性脑积水和颅内压增高,偶因脑疝猝死。本文报告经手术和尸检证实的81例第四脑室囊虫病,并对该病的诊断和治疗加以讨论。 临床资料 一般资料 男性53例,女性28例。5～10岁8例,11～15岁10例,16～30岁22例,31～50岁30例,51岁以上11例。最小年龄为5岁,最大年龄为59岁。学生18例,工人23例,农民38例,职员2例。病程最短20天,最长1年半,平均两个月。症状和体征(见表1)。 辅助检查 腰穿检查72例:颅内压180mm H_2O以下者10例,181～300mmH_2O者36例,300mm H_2O以上者26例;细胞数正常者6例,11～50/mm~3者48     

分流术后孤立性第四脑室1例

1临床资料患者男,60岁,因＂嗜睡、复视、走路不稳逐渐加重一年＂于2008年10月入院。诊断：第四脑室囊虫,脑积水。行后颅窝开颅,第四脑室脑囊虫切除术,术后第3天出现急性梗阻性脑积水,急诊行侧脑室额角穿刺引流术,引流过程中有脑脊液感染,待感染控制后行脑室-腹腔分流术,术后恢复良好,脑积水症状明显改善。5个月后,再次出现嗜睡,复视,吐字不清,     

脊髓蛛网膜下腔梗阻1例病例分析

目的探讨椎管内囊虫的疾病特点。方法回顾性分析1例椎管内囊虫病患者的临床表现、影像学资料、手术方式、病理报告、免疫学检查和治疗经过,并复习相关文献和总结椎管内囊虫的诊治。结果患者因双下肢进行性、上行性麻木伴行走不稳入院。胸腰椎MRI在T8-9椎体椎管内髓外硬膜下可见条片状异常信号,伴上段蛛网膜下腔扩张和下段脊髓表面蛛网膜强化。术中见硬膜下多个囊性病灶,取出病灶后可见大量脑脊液涌出。术后病理考虑为寄生虫感染性肉芽肿。进一步检查血清囊虫抗体示弱阳性,予吡喹酮治疗,患者恢复良好。结论椎管内囊虫病罕见,诊断需结合患者的临床表现、影像学和免疫学资料,以免误诊误治。     

脑积水脑室-腹腔分流术后并发肌震颤、肌张力增高三例

例1男,14岁。因头痛、视物不清、行走不稳10d入院。患者8个月前因同样的症状被诊断为梗阻性脑积水,在当地医院行脑室-腹腔分流术,术后原症状消失,复查头颅CT示原扩大的脑室恢复正常。入院前10d原症状复发,头颅CT示梗阻性脑积水。检查原分流的分流泵,分流泵按下后复位困难。行右侧侧脑室前角脑室-腹腔分流术,第2天     

Hydrocephalus and Neurocysticercosis: Cases Illustrative of Three Distinct Mechanisms

Background

Cysticercosis is the most frequent parasitic infection of the nervous system. Most lesions are intracranial, and spinal involvement is rare. We describe here in two cases of neurocysticercosis (NCC) in the brain and one in the spinal cord that illustrate three distinct mechanisms leading to symptomatic acute hydrocephalus.

Case Report

Hydrocephalus was related to intracranial NCC in two of them. In the first case the hydrocephalus was due to an extensive arachnoiditis to the craniocervical junction, while in the second it was caused by obstruction of Magendie''s foramen in the fourth ventricle by the scolex of Taenia solium. For the third patient, hydrocephalus revealed cysticercosis of the cauda equina due to the scolex.

Conclusions

NCC should be considered as a possible diagnosis for patients suffering from hydrocephalus when they originate from or have traveled in endemic areas, MRI of the spine is mandatory to search for intraspinal lesions.     

Isolated fourth ventricular cysticercus cyst: MR imaging in 4 cases with short literature review

We describe the magnetic resonance imaging (MRI) signal characteristics of isolated (solitary lesion) intra fourth ventricular cysticercus cyst in 4 patients who clinically presented with obstructive hydrocephalus. All patients had routine MRI sequences (T1, T2, & proton density-weighted imaging), Fluid Attenuation Inversion Recovery (FLAIR), and post-gadolinium imaging followed by cerebrospinal fluid (CSF) flow study. It revealed a CSF signal intensity (on all pulse sequences), intra fourth ventricular cyst with a nidus (scolex), and wall enhancement. On T1-weighted and FLAIR images, the cyst wall and nidus (scolex) were seen in 3 cases, which were not seen in other routine sequences. The CSF flow study showed the intraluminal nature of the cyst. The MRI features suspected a cysticercus cyst, and per-operative findings and histopathological examination confirmed the diagnosis. The review of literature of the intra fourth ventricular cyst is briefly discussed.     

Fourth ventricular neurocystercercosis presenting with acute hydrocephalus

Neurocysticercosis is an infection caused by the larvae of the pork tapeworm Taenia solium. Parenchymal lesions commonly present with seizure activity and intraventricular lesions can cause hydrocephalus. A 33-year-old female patient presented in a comatose state with acute hydrocephalus and a fourth ventricle lesion. She underwent placement of an external ventricular drain. Resection of the fourth ventricle lesion through a suboccipital approach allowed for restoration of normal cerebrospinal fluid (CSF) flow and relief of midbrain compression. The lesion was resected intact and the patient returned to normal neurological function. No CSF diversion procedure was necessary. The patient was discharged on cysticidal and steroid therapy. We concluded that surgical resection of lesions in the fourth ventricle attributed to neurocysticercosis is appropriate when brainstem compression is prominent. Resection may also avoid the need for permanent CSF diversion. We also reviewed the evidence-based management strategies described in the literature.     

Multilocular cysticeral and hydatid cysts of the brain: a report of three cases

Three cases of multilocular parasitic brain cysts are presented; two cases of specific form of neurocysticercosis and one case of multilocular hydatid cyst. MRI shows features seen in other cystic lesions of the CNS. In all cases the diagnosis was established by neurosurgical brain biopsy. The authors indicate that the parasitic disease should be taken into consideration in differential diagnosis of tumor-like cystic brain lesions.     

Taenia solium DNA is present in the cerebrospinal fluid of neurocysticercosis patients and can be used for diagnosis

Neurocysticercosis is the most frequent parasitic infection of the CNS and the main cause of acquired epilepsy worldwide. Seizures are the most common symptoms of the disease, together with headache, involuntary movements, psychosis and a global mental deterioration. Absolute diagnostic criteria include the identification of cysticerci, with scolex, in the brain by MRI imaging. We demonstrate here, for the first time, that T. solium DNA is present in the cerebrospinal fluid of patients. The PCR amplification of the parasite DNA in the CSF enabled the correct identification of 29/30 cases (96.7 %). The PCR diagnosis of parasite DNA in the CSF may be a strong support for the diagnosis of neurocysticercosis.     

An unusual form of superficially disseminated glioma in children: report of 3 cases

Three children, aged 4, 5, and 9 years, had an insidious onset of ataxia. Magnetic resonance imaging (MRI) showed hydrocephalus and countless foci of high T2 signal coating the cerebellum, basilar cisterns, brainstem, and fourth ventricle. Similar lesions were present in the spinal cord. Symptoms were relatively mild given the massive tumor burden. Biopsies were composed of superficially infiltrating cells with oligodendroglioma-like features (perinuclear halos and cytologic monotony) and microcysts. Classical cytogenetic analysis of 2 cases showed normal karyotypes. Chromosome fluorescence in situ hybridization revealed 1p36 deletion with intact 19q in 2 cases and no abnormality in one. A similar combination of clinical, MRI, and histopathologic findings has been reported previously in 10 other cases. The pathologic findings suggest a glioma with diffuse or multifocal superficial origin and do not correspond to a described entity in the current World Health Organization (WHO) classification of brain tumors.     

A Mexican case of massive nonencephalitic neurocysticercosis

Neurocysticercosis is common in Asia, Africa and South America including Mexico. A diagnosis of neurocysticercosis was made neuroradiologically in an 8-year-old Mexican girl, who had suffered from learning difficulties for a year, and subsequently developed headache, vomiting, gait disturbance, visual hallucination, apraxia and euphoric state for 4 months. Plain CT demonstrated numerous cystic lesions with or without scolex in addition to calcified lesions. The lesions were seen throughout the whole brain, although they were relatively scarce in the cerebellum and the lateral ventricular system. Although edema was prominent around the bilateral ventricles, neither ventricular dilatation, midline shift nor inflammatory reaction around the cysts was detected. The patient was treated with albendazole for a month and with steroid for two months. Headache and vomiting disappeared in the first week of treatment but other symptoms persisted, with fluctuation. CT after 2 months of treatment showed dilatations of the third and lateral ventricles. Despite massive infection in the brain, the clinical picture at onset was mild and compatible with nonencephalitic cerebral cysticercosis. The symptoms might be caused by the progressive hydrocephalus due to cerebrospinal fluid blockage, the prognosis of which is predicted to be poor.     

颅内表皮样囊肿20例

目的探讨颅内表皮样囊肿(EC)的临床与头颅MRI影像表现,以便提高诊断率。方法经手术病理证实的20例EC的MRI表现。全部患者均进行了常规平扫序列T_1WI、T_2WI、液体衰减反转恢复序列(FLAIR)及弥散加权成像(DWI)、钆对比剂增强扫描(CE-MRI)检查。结果 20例肿瘤脑桥小脑角池12例(左侧7例,右侧5例),桥前池3例,脑实质内2例(右侧枕叶1例,左侧额叶1例,病灶均发生于皮质区或皮质下区),左侧外侧裂池1例,枕大池1例,四脑室1例。其中4例病灶同时受累桥前池、鞍上池、侧裂池及环池等多个脑池间隙;全部病灶均呈囊性改变;13例长T_1WI、长T_2WI信号,4例T_1WI、T_2WI为混杂信号,3例T_1WI、T_2WI均为高信号;11例T_2FLAIR序列检查结果均呈混杂信号,其内可见散在的絮状稍高信号影,6例为低信号,3例为稍高信号;DWI序列检查结果为19例高信号,1例低信号。结论 EC的MRI表现具有特征性,尤其是FLAIR及DWI序列MRI表现有助于对该病的明确诊断。     

Clinical evaluation of an isolated fourth ventricle

Since the introduction of the CT scan in 1976, we have experienced 6 cases of the isolated fourth ventricle among 244 hydrocephalic patients (2.5%). Age at diagnosis of the isolated fourth ventricle ranged from 1 year 8 months to 13 years (mean age, 8 years, 6 months). The time interval between the first shunting procedure and the diagnosis of the isolated fourth ventricle varied from 1 year 5 months to 7 years 4 months (mean interval, 4 years 1 months). The prior hydrocephalus were due to intraventricular hemorrhage in two patients, meningomyelocele in a patient and brain tumor in three patients. Two patients had history of cerebrospinal fluid (CSF) infection and five cases underwent multiple shunt revisions. Posterior fossa signs were evident in all cases. It was quite easy to make a diagnosis of the isolated fourth ventricle with CT scan, which demonstrated a large rounded or pear-shaped midline cyst in the posterior fossa. Slit-like lateral ventricles were noted in three cases, while the remaining three had enlarged lateral ventricles. Ventriculography confirmed the isolation of the fourth ventricle in 5 cases. Metrizamide which had been injected into the fourth ventricle was diluted when CT scan was performed 48 hours later, and contrast medium disappeared since then. Magnetic resonance imaging (MRI) well showed the characteristic findings of the isolated fourth ventricle: cystic dilatation of the fourth ventricle, compression and distortion of the brain stem, upward tentorial herniation, occlusion of the aqueduct, downward displacement of the occipital lobe, septum formation of the fourth ventricle and accompanied anomalies such as, Chiari malformation or syringomyelia.(ABSTRACT TRUNCATED AT 250 WORDS)     

Endoscopic management of intraventricular neurocysticercosis.

Surgical management is the only option for patients presenting with acute hydrocephalus caused by intraventricular neurocysticercosis. Although various modalities have been described, endoscopic excision is becoming increasingly popular. The outcomes for 22 patients with intraventricular neurocysticercal cysts with hydrocephalus managed endoscopically are presented. Complete excision of cysts (fourth ventricle, 14; lateral ventricle, 4; third ventricle, 3; both lateral and third ventricles, 1) was performed in all patients. Internal procedures for cerebrospinal fluid diversion were performed in 20 patients. There were minimal perioperative complications, all patients were relieved of raised intracranial pressure and no patient has required shunting to date. Mean follow-up duration was 20.7 months. Follow-up imaging showed the absence of residual cysts and resolution of hydrocephalus in all patients.