Subarachnoid basal neurocysticercosis: A focus on the most severe form of the disease

Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.
Expert Review of Anti-infective Therapy (Impact Factor: 3.46). 01/2011; 9(1):123-33. DOI: 10.1586/eri.10.150
Source: PubMed


Neurocysticercosis is an endemic disease in Latin America, Asia and Africa with growing occurrence in industrialized countries due to the increase in migration from low- and middle-income to high-income countries. The most severe clinical presentation is when the parasite is located in the subarachnoid space at the base of the brain (NCSAB). Aside from its clinical presentation, the severity of this form of the disease is due to the difficulties in diagnosis and treatment. Although NCSAB frequency is lower than that reported for the parenchymal location of the parasite, its clinical relevance must be emphasized. We provide a critical review of the central epidemiological, clinical, diagnostic and therapeutic features of this particular form of the disease, which is still associated with unacceptably high rates of morbidity and mortality.

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    • "With respect to the scolices, we did not find any statistically significant differences in the sensitivity of the sequences, although FIESTA detected twice as much than the others. The absence of significant differences is probably due to the known low frequency of scolices found in extraparenchymal cysticerci (Fleury et al., 2011); in our work, only four parasites (8.5%) exhibited a scolex detectable by FIESTA sequences. This absence of scolex has been described as the result of hydropic degeneration, caused by the continuous absorption of cerebrospinal fluid by the vesicle, conditioning the characteristic size and morphology of the racemose form of cysticercosis (Escobar, 1983). "
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    ABSTRACT: Imagenological diagnosis of subarachnoid neurocysticercosis is usually difficult when classical magnetic resonance imaging (MRI) sequences are used. The purpose of this study was to evaluate the advantages of 3D MRI sequences [Fast Imaging Employing Steady-state Acquisition (FIESTA) and Spoiled Gradient Recalled Echo (SPGR)] with respect to classical sequences [Fluid Attenuation Inversion Recovery (FLAIR) and T1] in visualizing Taenia solium cyst in these locations. Forty-seven T. solium cysts located in the basal cisterns of the subarachnoid space were diagnosed in eighteen Mexican patients. A pre-treatment MRI was performed on all patients, and all four sequences (FIESTA, FLAIR, T1 SPGR, and T2) were evaluated independently by two neuroradiologists. The sensitivity of each sequence to detect the parasite membrane and scolex was evaluated, along with its capacity to detect differences in signal intensity between cerebrospinal fluid (CSF) and cysts. FIESTA sequences allowed the visualization of cyst membrane in 87.2% of the parasites evaluated, FLAIR in 38.3%, SPGR in 23.4%, and T2 in 17.0%. The superiority of FIESTA sequences over the other three imaging methods was statistically significant (P<0.001). Scolices were detected by FIESTA twice as much as the other sequences did, although this difference was not significant (P>0.05). Differences in signal intensity between CSF and parasite cysts were significant in FIESTA (P<0.0001), SPGR (P<0.0001), and FLAIR (P=0.005) sequences. For the first time, the usefulness of 3D MRI sequences to diagnose T. solium cysts located in the basal cisterns of the subarachnoid space was demonstrated. The routine use of these sequences could favor an earlier diagnosis and greatly improve the prognosis of patients affected by this severe form of the disease. Copyright © 2015. Published by Elsevier B.V.
    Full-text · Article · Aug 2015 · Acta tropica
    • "Acute hydrocephalus secondary to intraventricular cysts and chronic hydrocephalus due to arachnoiditis or ependymitis are the most frequent causes of this syndrome (Agapejev et al. 2007). Increased intracranial pressure also occurs in patients with the racemose form of NC and in those with cysticercal encephalitis (Cárdenas et al. 2010; Carpio 2002; Fleury et al. 2011). Spinal cord cysticercosis is rare (Alsina et al. 2002). "
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    ABSTRACT: Taenia solium cysticercosis affects both humans and pigs. It has been considered an eradicable disease, and yet its prevalence remains stable in most endemic countries, due to the persistence of risk factors usually associated with the marginalization of an important sector of the population. In this chapter we will review key aspects of its epidemiology, clinical features, diagnosis, treatment, and prevention.
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    • "Symptoms of neurocysticercosis are caused by either the inflammatory response of the host or mass effect and may present months or years after initial infection. Cyst location, stage (e.g., viable or degenerating), number, mass effect, and accompanying inflammation are the major determinants of symptomology, and extraparenchymal neurocysticercosis produces more serious disease.10–12 "
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    ABSTRACT: Cysticercosis is a potentially fatal and preventable neglected parasitic infection caused by the larval form of Taenia solium. Patients with symptomatic disease usually have signs and symptoms of neurocysticercosis, which commonly manifest as seizures or increased intracranial pressure. Although there are many persons living in the United States who emigrated from highly disease-endemic countries and there are foci of autochthonous transmission of the parasite in the United States, little is known about burden and epidemiology of the disease in this country. In addition, despite advances in the diagnosis and management of neurocysticercosis, there remain many unanswered questions. Improving our understanding and management of neurocysticercosis in the United States will require improved surveillance or focused prospective studies in appropriate areas and allocation of resources towards answering some of the key questions discussed in this report.
    Preview · Article · May 2014 · The American journal of tropical medicine and hygiene
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