脑囊虫病患者血清循环抗原、IgG4与神经影像学关系研究

目的探讨脑囊虫病血清循环抗原（CAg）、特异性IgG4与神经影像学（CT、MRI）的关系。方法对根据Del Brutto等于2001年提出的诊断脑囊虫病的四个标准确诊的36例脑囊虫病患者分别行CAg定量测定、IgG4定性测定及神经影像学检查。结果按照神经影像学变化,脑囊虫可分为活虫期、变性死亡早期、变性死亡后期及钙化期,其各期之间的患者血清CAg水平有显著差异（P〈0．05）。血清中CAg的含量及血清特异性IgG4阳性强度与脑囊虫病的神经影像学分期呈显著正相关（r=0．871,0．602,P〈0．01）。结论①脑囊虫病人血清CAg、IgG4水平与神经影像学（CT、MRI）表现具有相关性;②血清CAg和特异性IgG4的检查可用于脑囊虫病的早期诊断和指导其临床治疗。     

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。     

实质型脑囊虫病的MRI分期诊断与临床病理研究

目的 探讨实质型脑囊虫病的MRI表现与病理改变的对应关系，旨在提高其诊断水平。方法 对50例临床、病理证实的脑囊虫病患者的MRI表现进行了分析。结果 （1）活虫期：MRI表现为囊状长T1长T2信号，囊壁光滑且与头节均呈等T1等T2信号；（2）变性死亡早期：MRI表现为虫体周围见长T1长T2信号水肿带，囊壁增厚、头节可见，增强后可出现环状增强；（3）变性死亡后期：MRI表现水肿范围缩小或消失，头节消失，囊壁增厚；（4）钙化纤维化期：虫体死亡并钙化，MRI表现为长T1短T2信号灶。结论 实质型脑囊虫病的MRI分期诊断对临床治疗有其重要的指导意义。     

循环抗原、抗体和MRI在脑囊虫病程演变中的变化

囊虫病系绦虫的幼虫即囊尾蚴寄生于人体所致,全世界每年约有5万人因此而死亡。它可以寄生于人的皮下、肌肉、眼睛等,其中对健康危害最大的是寄生于中枢神经系统犤1犦。在本研究中,用单克隆抗体采用ELISA方法检测脑囊虫病人血清、脑脊液中循环抗原(CAg)和抗体(Ab)在MRI影像学的不同时期的变化,以进一步明确脑囊虫病人的病程演变情况。资料与方法1.一般资料:45例患者,男29例,女16例,年龄4.6～75岁,平均35.6岁。2.临床诊断:45例患者中,21例为神经外科收住并经手术病检证实,24例经神经内科确诊为脑囊虫并治疗有效。3.影像学检查:对脑囊虫病…     

脑囊虫病不同分期的影像学表现

目的 探讨囊虫病的分型、分期的影像学表现特征.方法 回顾性分析94例脑囊虫病患者的CT及MRI的特点.结果 94例中脑实质型74例,脑室型8例,混合型11例,软脑膜炎型1例;处于活动期25例,退变死亡期29例,钙化期4例,混合期36例.各期CT与MRI表现均不同.结论 不同脑囊虫病的病理学过程和影像学表现不同,它的分型、分期对指导临床治疗有着重要意义.     

猪绦虫患者及周围人群囊虫病感染情况调查研究

1993～1997年，分别在夏邑和对来自全省各地就诊的绿虫患者及家门，进行员虫病调查，并与正常人群进行了对比分析。材料与方法1、调查人群：选定邑县的会事、业庙、济阳、何营4个乡（镇）居民和来自全国各地的绦虫病患者及家属为调查研究对象。2、调查方法：对绦虫病患者及其家属和研究区居民进行血清猪粪尾顿特异性循环抗原（CAg）和循环抗体（CAb）检测，对CAg和（或）CAb阳性者，和（或）有癫病、精神障碍、皮下结节、长期不明原因的头痛、头晕等症状、体征之一者，进行详细检查，必要时通过CT或（MRI）影像进一步检查，脑囊虫病诊…     

脑囊虫病分期分型的MRI征象分析

目的：回顾分析62例脑囊虫病MRI分期分型表现,探讨MRI对脑囊虫病诊断价值。方法：62例根据病史、临床及MRI表现,囊虫补体试验阳性,增强扫描及穿刺病检和治疗随访观察确诊者61例。手术与病理证实者1例。结果：脑实质型60例,其中活虫期6例,变性死亡期8例,非活动期2例,混杂期14例,脑室型、混合型各1例。结论：MRI对显示脑囊虫病发生的部位、数目、范围、形态及分期分型提供了可靠的诊断依据。     

脑囊虫病分期分型的MRI征象分析

目的 :回顾分析 6 2例脑囊虫病MRI分期分型表现 ,探讨MRI对脑囊虫病诊断价值。方法 :6 2例根据病史、临床及MRI表现 ,囊虫补体试验阳性 ,增强扫描及穿刺病检和治疗随访观察确诊者 6 1例。手术与病理证实者 1例。结果 :脑实质型 6 0例 ,其中活虫期 6例 ,变性死亡期 8例 ,非活动期 2例 ,混杂期 14例 ,脑室型、混合型各 1例。结论 :MRI对显示脑囊虫病发生的部位、数目、范围、形态及分期分型提供了可靠的诊断依据     

偏瘫为主要表现的神经囊虫病2例并文献复习

目的探讨以偏瘫为主要表现的神经囊虫病的临床表现、鉴别诊断、治疗和预后。方法报告2例以偏瘫为主要表现的神经囊虫病,结合文献复习,介绍其临床表现、鉴别诊断及手术治疗。结果在显微镜下或内镜下摘除囊虫术后痊愈出院。结论以偏瘫为主要表现的神经囊虫病在临床工作中并不多见,以基底节区及其附近的占位效应为主要影像学表现,术前依据CT、MRI等检查可明确诊断,治疗采用显微镜下手术摘除囊虫或神经内镜下摘除囊虫,可早期对被挤压的神经细胞及神经纤维进行减压。     

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）,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％）     

Evaluation of cysticercus fasciolaris antigen for the immunodiagnosis of neurocysticercosis.

Cysticercus cellulosae antigen has been frequently used to detect antibodies for immunodiagnosis of neurocysticercosis. We have, for the first time, used membrane extract of cysticercus fasciolaris, the larval stage of Taenia taeniaeformis, in ELISA, with successful results. IgM and IgG antibodies against cysticercus were measured in serum from cases of neurocysticercosis (217), normal and diseased controls (89). 203 sera from cases of neurocysticercosis were positive for either or both IgG and IgM antibodies while 157/217 cases showed IgM and 158/217 showed IgG antibodies. Ten controls showed false postivity in IgG ELISA. Eight of these cases also had IgM antibodies. The test had an overall sensitivity of 93.54% and a specificity of 84.2% with a positive predictive value of 93.54% and a negative predictive value of 84.2%. Cysticercus fasciolaris can be conveniently produced in the experimental laboratory host, Rattus rattus, and would be of practical value in the immunodiagnosis of cysticercosis in humans.     

Immunochemical detection of antigens of larval Taenia solium and anti-larval antibodies in the cerebrospinal fluid of patients with neurocysticercosis

A simple and quantitative enzyme-linked immunosorbent assay (ELISA) has been developed for the detection of antigens of larval Taenia solium in the cerebrospinal fluid (CSF) of patients with cerebral cysticercosis. Another ELISA was developed for detecting antibodies in CSF against larval antigens. The examination of sixteen patients with clinical diagnosis of cerebral cysticercosis revealed that eleven patients had both circulating larval antigens and anti-larval IgG (but not IgM) antibodies in their cerebrospinal fluids. Of these patients, those with surgically and histologically confirmed infections were all positive by the two tests. CSF samples from nine normal individuals and from six patients suffering from proven neurological disorders other than neurocysticercosis were negative for both tests. In development of these assays it was found that cross-linking of antigens to microtiter plates further improved the performance of the ELISA. The results of this study suggest that either or both of these tests may be useful in discriminating between neurocysticerosis and other clinically related diseases.     

Proposed diagnostic criteria for neurocysticercosis

Neurocysticercosis is the most common helminthic infection of the CNS but its diagnosis remains difficult. Clinical manifestations are nonspecific, most neuroimaging findings are not pathognomonic, and some serologic tests have low sensitivity and specificity. The authors provide diagnostic criteria for neurocysticercosis based on objective clinical, imaging, immunologic, and epidemiologic data. These include four categories of criteria stratified on the basis of their diagnostic strength, including the following: 1) absolute--histologic demonstration of the parasite from biopsy of a brain or spinal cord lesion, cystic lesions showing the scolex on CT or MRI, and direct visualization of subretinal parasites by funduscopic examination; 2) major--lesions highly suggestive of neurocysticercosis on neuroimaging studies, positive serum enzyme-linked immunoelectrotransfer blot for the detection of anticysticercal antibodies, resolution of intracranial cystic lesions after therapy with albendazole or praziquantel, and spontaneous resolution of small single enhancing lesions; 3) minor--lesions compatible with neurocysticercosis on neuroimaging studies, clinical manifestations suggestive of neurocysticercosis, positive CSF enzyme-linked immunosorbent assay for detection of anticysticercal antibodies or cysticercal antigens, and cysticercosis outside the CNS; and 4) epidemiologic--evidence of a household contact with Taenia solium infection, individuals coming from or living in an area where cysticercosis is endemic, and history of frequent travel to disease-endemic areas. Interpretation of these criteria permits two degrees of diagnostic certainty: 1) definitive diagnosis, in patients who have one absolute criterion or in those who have two major plus one minor and one epidemiologic criterion; and 2) probable diagnosis, in patients who have one major plus two minor criteria, in those who have one major plus one minor and one epidemiologic criterion, and in those who have three minor plus one epidemiologic criterion.     

Neurocysticercosis and epilepsy: Imaging and clinical characteristics

The ILAE Neuroimaging Task Force aimed to publish educational case reports highlighting basic aspects related to neuroimaging in epilepsy consistent with the educational mission of the ILAE. Neurocysticercosis (NCC) is highly endemic in resource-limited countries and increasingly more often seen in non-endemic regions due to migration. Cysts with larva of the tapeworm Taenia solium lodge in the brain and cause several neurological conditions, of which seizures are the most common. There is great heterogeneity in the clinical presentation of neurocysticercosis because cysts vary in number, larval stage, and location among patients. We here present two illustrative cases with different clinical features to highlight the varying severity of symptoms secondary to this parasitic infestation. We also present several examples of imaging characteristics of the disease at various stages, which emphasize the central role of neuroimaging in the diagnosis of neurocysticercosis.     

Evaluation of the enzyme-linked immunoelectrotransfer blot assay for diagnosis of neurocysticercosis in children

Neurocysticercosis is a common problem in developing countries, and it causes neurologic disorders in children. Immunodiagnosis with Taenia solium glycoproteins as an antigen has been validated in adults but not in children. The aim of this work was to evaluate a Taenia solium glycoproteins-based enzyme-linked immunoelectrotransfer blot assay in children with neurocysticercosis. Twenty-five confirmed cases of neurocysticercosis and 50 healthy children from the same community were included. The test had a sensitivity of 72% and a specificity of 96%. Sensitivity was higher (100%) in cases with multiple cysts and in multiple sites. Sensitivity was higher when cysts were in parenchyma (86%) than when they were in the subarachnoid space. The most frequently recognized proteins were 24, 39 to 42, and 50 kDa. Diagnosis was more efficient in serum than in cerebrospinal fluid. Western blot is a reliable method for serologic diagnosis of neurocysticercosis in children. Multiple cysts and infections in multiple sites elicited a stronger immune response.     

Neurocysticercosis masquerading as a cerebral infarct

The differential diagnosis of acute focal neurologic deficit in childhood is diverse. We report the case of a child presenting with an acute hemiparesis persisting for longer than 24 hours following a focal seizure. The clinical history, examination findings, and results of cranial magnetic resonance imaging (MRI) were initially interpreted as consistent with an arterial ischemic cerebral infarction. Follow-up cranial MRI performed 9 months later revealed changes indicative of neurocysticercosis. Review of original neuroimaging resulted in a revision of the diagnosis to neurocysticercosis. The clinical history, together with neuroimaging findings, is highly compatible with a diagnosis of neurocysticercosis but unusual because it occurred in a child resident in a nonendemic area who had never traveled to an endemic area and whose diet excluded pork. The case reported raises two important issues. The first is the need to carefully consider the differential diagnosis of acute hemiparesis, including unusual causes. Second, it raises awareness of the potential for neurocysticercosis to occur in low-risk patients in nonendemic areas.     

Detection of mycobacterial antigen in cerebrospinal fluid: diagnostic and prognostic significance

Inhibition enzyme-linked immunosorbent assay (ELISA) was standardised to quantitate circulating mycobacterial antigens in cerebrospinal fluid (CSF) specimens. Of the 40 patients with clinical diagnosis of tuberculous meningitis, the assay was found to be positive in 26 patients. In a control group of 42 patients with non-tuberculous neurological diseases the assay was negative. The assay showed a sensitivity of 65 and 100% specificity for tuberculous meningitis. In 8 patients with tuberculous meningitis receiving chemotherapy, multiple CSF examinations were subjected to this assay. The antigen concentration showed a gradual decrease between 3 and 4 weeks after the commencement of antituberculosis chemotherapy. There was a positive correlation between clinical recovery and antigen concentration. Detection of mycobacterial antigen in CSF specimen by inhibition ELISA has not only diagnostic utility but also could be applied to monitor antituberculosis chemotherapy in patients with tuberculous meningitis. The assay is reproducible and feasible for routine immunology laboratory. It also could be considered as a diagnostic aid when repeated bacteriological cultures are negative in CSF specimens of patients with tuberculous meningitis.     

Analysis of serum of patients with Alzheimer's disease for the level of advanced glycation end products

Data on the serum level of advanced glycation end products (AGEs) in Alzheimer's disease (AD) patients are scarce, although a specific biochemical marker easy to detect in body fluids is desired for an early diagnosis of disease and to monitor the effects of therapeutic treatment. In the current study, the content of AGEs was examined with an immunochemical assay in the sera of AD patients, in the frame of a search for a biochemical marker of disease. Subjects with AD and vascular dementia (VaD) were included in the study (n = 30; age range, 68-70 years). The results were compared to the healthy control groups. The enzyme-linked immunosorbent assay (ELISA) inhibition test for the determination of AGEs is based on a rabbit anti-AGE, affinity-purified antibody and a model AGE-myoglobin antigen, in which a serum sample treated with proteinase K is used as an inhibitor. For the measurement of immune complexes and anti-AGE antibodies, the corresponding ELISA tests have been applied. The AGE level in the VaD group (49.5 U(AGE)) was higher than in AD patients (46.1 U(AGE)). The level of total AGEs in the sera of AD patients was significantly lower than in the control group (50/51.6 U(AGE)). These relations were not observed with regard to the immune complexes and anti-AGE antibody levels in AD (70.2 U(IC)/0.027 U(IgG)) and VaD (83 U(IC)/0.034 U(IgG)) patients because the levels of these parameters were similar to the controls (76.2 U(IC)/0.042 U(IgG)). The work revealed the lower level of circulating serum AGEs in patients with AD in relation to healthy controls.     

Neurocysticercosis in Infants and Toddlers: Report of Seven Cases and Review of Published Patients

Neurocysticercosis in infants and toddlers has received little attention in the literature, and little is known about the mechanisms of disease acquisition and clinical forms of presentation of the disease in this age group. All patients aged ≤3 years with neurocysticercosis evaluated at Hospital-Clínica Kennedy, Guayaquil, over a 22-year period were included in this study. Their household contacts were screened to detect Taenia solium carriers, which may represent the source of infection. A literature search on neurocysticercosis in infants and toddlers was also performed to compare personal cases with those described elsewhere. A total of 25 infants and toddlers with neurocysticercosis were included (seven from our institution and 18 from the literature). All patients had seizures as the primary manifestation of the disease, and neuroimaging studies showed one or two parenchymal brain cysticerci in the colloidal stage in 88% of patients. The source of infection was investigated in 11 houses, including the seven households of the present series, and only four of the 18 reported in the literature. A Taenia carrier was found in five (45%) of these households, including three from the present series and two from the literature. A sizable proportion of infants and toddlers with neurocysticercosis have been infected at home. Compulsory search of Taenia carriers among household contacts will allow the detection of the potential source of infection and will reduce further spread of the disease. The search must not be limited to family members, but also extended to domestic employees who are in daily contact with the children.