Single parenchymal brain cysticercus: relationship between age of patients and evolutive stage of parasites

Abstract

Background: A recent hypothesis suggested that in many cases cysticercal granulomas represent recently established Taenia solium metacestodes rapidly destroyed by the host’s immune system. Here, we attempted to determine whether patients with cysticercal granulomas are younger than those with other forms of parenchymal brain cysticercosis.

Methods: Series of 185 patients with single parenchymal brain cysticercus, classified according to the stage of the parasite at the moment of diagnosis in cysts without inflammation, cysts with inflammation, granular lesions, and calcifications. We correlated the age of the patients with the parasite evolutive stage.

Results: Patients with cysticercus granulomas were significantly younger than those with vesicular cysts (17·7±12·9 versus 36·8±15·1 years, P<0·005) or calcifications (17·7±12·9 versus 40·8±19·7 years, P<0·0001). There was also a non-significant trend for patients with granulomas to be younger than those with coloidal cysts (17·7±12·9 versus 26·7±15·6 years, P?=?0·367).

Conclusions: Results from this study argued against the classical hypothesis that granulomas are the end result from long-established vesicular cysts destroyed by the host’s immune system. Vesicular (viable) cysticerci must be treated with cysticidal drugs as it is unlikely that they will be spontaneously destroyed.     

Tumor form of neurocysticercosis: surgical removal of a cysticercus measuring 70X77 mm and treatment with praziquantel

The authors report a case of a female patient, age 22, who presented episodes of focal seizures, right hemiparesis and dysphasia of five months duration. The neurologic exam revealed bilateral papilledema and computarized tomography of the head showed a cystic lesion (70X77 mm) in the left fronto-temporo-parietal area, midline shift and similar lesions scattered in the brain parenchyma. She was submitted to a left craniotomy with the diagnosis of cerebral cysticercosis and the major cyst (Cysticercus racemosus) and a small cortical cyst (10X10 mm) were removed to aliviate the increased intracraneal pressure and for histopathological examination. Thirteen days after surgery she was discharged without neurological deficits, except mild papilledema. One month later she was treated with praziquantel (50 mg/kg/day) during 21 days. The CSF examination was normal before the treatment started and showed a transient eosinophilic cellular reaction with positivation of the complement fixation test for cysticercosis while on treatment. The CT-Scan performed before the medical treatment revealed ventricular dilatation and several low density areas (10 to 40 mm) scattered in the cerebral parenchyma, including the operative site. CT-Scan performed three months later showed small low density areas only in the left cerebral hemisphere, including the operative site, calcification in the parenchyma, and slight dilatation of the left lateral ventricle. The clinical evolution was uneventful and the neurologic examination was normal three months later.     

Asystolias in the acute phase of brain stroke. Report of a case

Brain areas involved in heart autonomic control are not well characterized. Insulae have been proposed as control centers. A lesion in these areas may induce a cardiac autonomic dysfunction (arrhythmias, atrioventricular conduction abnormalities). Asystolia has not been previously reported. A 65-year-old man suffered an acute ischemia of the right middle cerebral artery (MCA) territory. NIHSS score was 19 points. Brain CT scan was normal. Transcranial Doppler (TCD) showed occlusion of the right MCA. Fibrinolysis was initiated 135 minutes after stroke onset with TCD monitoring. Twenty minutes later he suffered cardiac arrest with asystolia trace in the ECG monitor. Fibrinolysis was stopped during resuscitation. Four minutes later, he recovered with the same NIHSS score. Aggressive resuscitation maneuvers were not necessary. A repeated brain CT scan showed infarct signs in the whole MCA territory and a new TCD did not show any change. Serial blood analyses including cardiac nzymes were normal. The patient experienced four brief cardiac arrests in the next nine hours, so a temporary cardiac pacemaker was placed for four days. He was treated with aspirin and was discharged 14 days after admission. He has not experienced recurrences during a 6-month follow-up. We could not diagnose the etiology of the cardiac arrests. All the episodes occurred in the acute stroke stage and arrhythmia, atrioventricular block, myocardial ischemia or structural lesions were not found in the cardiac study. We propose that ischemia in the right insula induced sudden and transitory interruptions of the sympathetic cardiac tone.     

颅脑损伤伴颅内感染患者的临床特点和急性期预后的影响因素

目的分析颅脑损伤后发生颅内感染患者的病原菌特点,探讨与急性期预后相关的影响因素。方法选取2011-04—2014-09在我院行颅脑手术的颅脑损伤患者300例,对术后发生颅内感染情况、病原菌的分布特点及影响急性期预后的相关因素进行分析。结果 300例颅脑损伤患者中发生颅内感染64例,感染率21.33%。其中年龄12岁或60岁、脑脊液漏、手术部位在幕下、手术时间4h、未进行清洁手术、术后放置引流管48h、脑室外引流1周的患者感染率显著升高(P0.05);术前抗生素的使用对颅内感染的发生影响不显著。脑脊液培养共分离出38株病原菌,其中鲍曼不动杆菌占主要部分,构成比26.32%,金黄色葡萄球菌次之,构成比18.42%。结论年龄12岁或60岁、脑脊液漏、手术部位在幕下、手术时间4h、未进行清洁手术、术后放置引流管48h、脑室外引流1周是发生颅内感染及影响急性期预后的危险因素,手术过程中应尽量避免,以减少颅内感染的发生,改善急性期预后。     

Utility of the cysticercus immunoblot in a patient with an atypical solitary cerebral cysticercus granuloma

The value of the enzyme linked immunotransfer blot (EITB) assay in avoiding an invasive diagnostic procedure in a patient with an atypical solitary cerebral cysticercus granuloma is presented.     

You drive me crazy: a case report of acute psychosis and neurocysticercosis.

Cysticercosis is a parasitic disease endemic in several developing countries where people consume raw or insufficiently cooked pork. The authors present a clinical picture of an organic psychosis in a 24 year old female with CNS cysticercosis. The neuroradiologic follow-up of this patient pre and post treatment with praziquantel is presented. The implications of this case with regard to the pathophysiology of schizophrenia and schizophrenia-like psychoses is discussed.     

Circadian rhythm abnormalities in the acute phase of cerebral infarction correlate with poor prognosis in the chronic phase

The aim of this study was to determine circadian rhythm abnormalities in patients with acute cerebral infarction and their relationship with prognosis in the chronic phase. The subjects were 50 patients who were admitted within 48 h of onset. Rectal temperature and wrist motor activity were recorded during the acute phase. Time-series data were assayed by MEM spectral analysis. Functional prognosis (degree of handicap) was assessed at 3 months after stroke onset by the modified Rankin Scale. Ambulatory patients tended to exhibit circadian rhythm in rectal temperature and/or wrist activity rhythms, whereas non-ambulatory patients did not (P < 0.001) in the acute phase of ischemic stroke. Our findings suggest the biological rhythms of rectal temperature and wrist activity during the acute stroke phase might be a possible prognostic indicator of their chronic phase.     

Hereditary benign chorea: clinical and genetic features of a distinct disease.

OBJECTIVE: To describe a second family with benign hereditary chorea (BCH, OMIM 118700) and suggestive linkage to chromosome 14q. BCH is an autosomal dominant disorder of early onset that differs from Huntington disease in being nondementing and nonprogressive without other neurologic signs. There has been controversy regarding the existence of BCH as a discrete disorder. BACKGROUND: A single kindred was recently reported with linkage of BCH to a 20.6-KcM region on chromosome 14q. METHODS: In a four-generation family with BCH, linkage was evaluated to markers in a 23-KcM region between D14S49 and D14S66 that contains the putative BCH locus. RESULTS: A multipoint nonparametric lod score of 3.01 is consistent with linkage of disease in this family to the 14q BCH locus. A recombination event in one affected individual enabled the critical region to be narrowed to 6.93 KcM flanked by D14S1068 and D14S1064. This region contains two candidate genes: glial maturation factor beta and guanosine triphosphate cyclohydrolase 1 (GCH1). Survival motor neuron (SMN) interacting protein-1 is eliminated as a candidate gene because it lies outside the critical region. No sequence alteration was identified in the coding region of GCH1 in an affected individual. CONCLUSION: These data provide further evidence that BCH is a distinct entity, narrow the location of BCH to a 6.93-KcM region on chromosome 14q, and exclude SMN interacting protein-1 as a candidate gene.     

Alzheimer disease with amygdala Lewy bodies: a distinct form of alpha-synucleinopathy

Lewy bodies (LBs) are alpha-synuclein-immunoreactive neuronal inclusions with a predilection for specific cortical and subcortical regions, including the amygdala. In this study, the presence of LBs was assessed in 347 cases of Alzheimer disease (AD). In 87 cases, LB pathology was diagnostic of brainstem (n=3), transitional (n=32), or diffuse (n=52) Lewy body disease (LBD). The remaining 260 cases of AD were screened for amygdala LBs (AD/ALB) and 62 (24%) cases were found. If AD/LBD cases are included, LBs were detected in 149 (43%) cases of AD. The presence alpha-synuclein pathology was assessed in multiple brain regions of the 62 cases of AD/ALB and 57 randomly selected cases of AD, and only sparse alpha-synuclein pathology was detected in both. The burden of alpha-synuclein pathology in brainstem nuclei, amygdala, and neocortex was significant lower in AD/ALB than in AD/LBD. In comparison to AD/LBD, AD/ALB did not differ in age at death, disease duration, male-to-female ratio, brain weight, Braak neurofibrillary tangle stage, average senile plaque density, or apolipoprotein E epsilon4 allele frequency. The results suggest that AD/ALB is pathologically different from AD/LBD, suggesting that it is a neuropathologically distinct and isolated alpha-synucleinopathy.     

Intravenous methyl prednisolone in patients with solitary cysticercus granuloma: a random evaluation.

PURPOSE: To evaluate the role of intravenous methyl prednisolone in patients with solitary cysticercus granuloma with new-onset seizures. METHODS: In this open-label, randomized, prospective, follow-up study, 52 patients with new-onset seizures and a single enhancing CT lesion of cysticercus were randomly divided in two groups to receive either intravenous methyl prednisolone for 5 days along with antiepileptic drug (n=25) or antiepileptic drug monotherapy (n=27) alone. The patients were followed up for at least for 9 months. Repeat CT scans were performed after 2 months. RESULTS: After 2 months, lesion disappeared in 60% patients of intravenous methyl prednisolone group and 18.5% patients receiving only antiepileptic drug (p=0.001). As far as seizure recurrence was concerned, a lower number (16% versus 33%) of intravenous methyl prednisolone treated patient had recurrence, the difference was insignificant. CONCLUSION: Intravenous methyl prednisolone therapy helps in early resolution of solitary cysticercus granuloma.     

凝血功能异常对急性颅脑损伤患者预后的影响

目的 探讨凝血功能异常对急性颅脑损伤患者预后的影响.方法 选取2010-01-2012-03来本院就诊的重型颅脑损伤186例为实验组,选取本院同期健康体检者70例为对照组,检测PT、Fb、D-D、Plt含量.实验组患者均于入院24 h、3 d、7 d、14 d时检测凝血指标,对照组晨起抽取空腹血检测.结果 实验组患者入院24 h内凝血功能异常发生率42.47%（79/186）,入院3 d发生率24.19%（45/186）,入院7 d发生率4.79%（8/167）,入院14 d发生率3.27%（5/153）.入院24 h内凝血功能异常发生率显著高于7、14 d,差异有统计学意义（P〈0.05）.实验组患者入院后24 h内PT、Fb、D-D、Plt与对照组比较,差异均有统计学意义（P＜0.05）;入院7、14 d,D-D显著高于对照组,差异有统计学意义（P＜0.05）.结论 对颅脑损伤患者病情及预后的评估,不能仅依靠影像学手段,同时要参考凝血功能等实验室检查.     

Inducing ketogenesis via an enteral formulation in patients with acute brain injury:a phase II study

ABSTRACT

Objective: Although extensively studied in children, the safety and tolerability of ketone supplementation in adults is unclear, particularly in the acute brain injury population. The purpose of this study was to examine the feasibility and safety of inducing ketosis using an enteric ketogenic formulation and determine its impact on intracranial and cerebral perfusion pressures and metabolic parameters.

Methods: Prospective interventional Phase II trial of ventilated critically ill patients with acute brain injury administered a ketogenic feed over a 6 day period.

Results: 20 patients were recruited, 5 females and 15 males, 3 with stroke, 2 with subarachnoid haemorrhage and 15 with traumatic brain injury. Feeds were well tolerated with 19 patients completing study. There was a significant increase in both plasma beta-hydroxybutyrate and acetoacetate from 0.24± 0.31 mmol/l and 0.19 ± 0.16 mmol/l to 0.61 ± 0.53 mmol/l (p =0.0005) and 0.52 ± 0.40 mmol/l (p<0.0001) respectively over the 6 day period. Total daily Ketocal® caloric intake was positively correlated with plasma beta-hydroxybutyrate concentrations (p=0.0011). There was no significant correlation between the cerebral hypertension and cerebral hypoperfusion indices and plasma ketone concentrations. In 95% of patients there were no clinically significant changes in acid/base status over the 6 days with pH remaining within normal range.

Conclusion: In patients with acute brain injury, an enterally administered ketogenic formulation increased plasma ketone concentrations, was well tolerated, did not impact on cerebral hemodynamics and can be safely administered.

Clinical trial registered at the Australian New Zealand Clinical Trials Registry (ACTRN12616000332426)

Abbreviations: BHB: betahydroxybutyrate; AcAc: acetoacetate; ABI: acute brain injury; TBI: traumatic brain injury; CSF: cerebrospinal fluid; SAH: subarachnoid injury; CVA: cerebrovascular accidents; ICP: intracranial pressure; CPP: cerebral perfusion pressure; ICU: intensive care unit; EVD: external ventricular device; CHI: cerebral hypoperfusion index; IHI: intracranial hypertension index; GCS: Glasgow Coma Scale     

Single case study. Contact epilepsy: a rare form of reflex epilepsy.

An 80-year-old male is presented who had violent myoclonic seizures with occasional brief loss of consciousness, triggered by tactile stimuli directed to the upper extremities and upper part of the trunk which evolved over a 10-year period. Physical examination revealed very few neurological abnormalities. His resting electroencephalograms were normal, but generalized spikes, polyspikes, and slow wave discharges were precipitated by tactile stimuli with the patient sitting up. He showed no significant response to standard anticonvulsant therapy. The relevant literature is reviewed briefly.     

Contrast transcranial Doppler examination in the acute phase of a paradoxical brain embolism associated with pulmonary thromboembolism

The right-to-left shunt is often diagnosed by transcranial Doppler (TCD) with saline contrast with Valsalva's maneuver or cough. In the acute phase of stroke, however, Valsalva's maneuver or cough could not always be performed because of the patient's aphasia or consciousness disturbance. We report an acute aphasic stroke patient with a pulmonary thromboembolism who is diagnosed as having a right-to-left shunt by using TCD with saline contrast without Valsalva's maneuver or cough. In patients who have embolic stroke of undetermined cause, even if they cannot perform Valsalva's maneuver or cough because of aphasia or consciousness disturbance, TCD with saline contrast in the acute phase of stroke may be helpful for diagnosis of a paradoxical embolism.     

血压对糖尿病并发脑梗死急性期预后的影响

目的探讨血压对糖尿病脑梗死急性期预后的影响。方法对85例合并与不合并高血压的糖尿病脑梗死患者进行了回顾性分析。结果合并高血压组血糖明显高于无高血压级（11．20±4．22mmol／L对8．00±3．84mmol／L,P＜0．05）;且恶化死亡率（8／57,14％）亦明显高于无高血压组（0／28,0％,P＜0．05）。结论合并高血压的糖尿病脑梗死恶化死亡率高。     

神经外科重型颅脑创伤急性期血压变异性对患者近期预后的影响研究

目的探讨神经外科重型颅脑创伤(TBI)急性期血压变异性对患者近期预后的影响。方法选取110例重型TBI患者作为研究对象,根据格拉斯哥预后(GOS)评分分为预后良好组(n=53)和预后不良组(n=57),对两组患者术后3d内的血压变异性进行对比分析。结果预后良好组的平均年龄明显低于预后不良组,GCS评分、APACHEⅡ评分均明显高于预后不良组,P0.05。预后良好组入院24h的收缩压标准差、舒张压标准差、收缩压变异系数均显著低于预后不良组,入院72h的收缩压标准差、舒张压标准差、收缩压变异系数、舒张压变异系数均显著低于预后不良组,P0.05。APACHEⅡ评分是患者预后的保护因素,TBI程度、72h SD(SBP)是患者预后的危险因素。结论急性期血压变异性与重型TBI患者的预后密切相关,其影响患者预后的独立危险因素。     

急性期血浆脑钠肽水平与缺血性脑卒中近期预后关系分析

目的 探讨缺血性脑卒中患者急性期血浆BNP水平与近期预后的关系.方法 选取43例缺血性脑卒中急性期患者为研究对象,所有研究对象均在入院第2天清晨空腹抽血行BNP测定.将同期门诊40例中老年健康体检者为对照组.比较2组血浆BNP水平,同时比较不同预后缺血性脑卒中患者首次血浆BNP水平.结果 缺血性脑卒中患者组血浆BNP浓度高于对照组(P＜0.01);而近期预后不良的缺血性脑卒中患者急性期血浆BNP水平较近期预后良好的患者高(P＜0.01).结论 缺血性脑卒中患者急性期血浆BNP水平与缺血性卒中近期预后有密切关系.     

Multifocal vacuolar leucoencephalopathy: a distinct HIV-associated lesion of the brain

A 20-year-old male AIDS patient developed rapidly progressive dementia for more than 3 months prior to death. Autopsy showed, in addition to adrenal cytomegalovirus (CMV) infection and focal cerebral necrosis due to toxoplasmosis, multifocal subcortical white matter lesions of the brain which were strikingly similar to the histopathology of vacuolar myelopathy in AIDS. These distinct lesions contained macrophages which were rarely multinucleated and expressed HIV antigens by immunocytochemistry. The distribution of lesions mimics extrapontine myelinolysis and progressive multifocal leucoencephalopathy (PML); PML was excluded by the absence of papovaviruses by immunocytochemistry and by in situ DNA hybridization. Tissue damage in multifocal vacuolar leucoencephalopathy is different from hitherto characterized HIV-specific neuropathology such as HIV encephalitis and HIV leucoencephalopathy, and should be included in the list of conditions with damage of the brain white matter in AIDS.     

Rate of spontaneous resolution of a solitary cysticercus granuloma in patients with seizures.

The rate of spontaneous resolution of a recently diagnosed solitary cerebral cysticercus granuloma as visualized on CT scan was prospectively studied in 210 patients presenting with seizures. The proportion of granulomas that had resolved completely at different time intervals after the index scan was 18.8% at 3 months, 36.4% at 6 months, and 62.5% at 1 year. There is considerable variation in the natural history of a solitary cysticercus granuloma in a patient presenting with seizures.