Garcia HH, Del Brutto OH. Neurocysticercosis: updated con- ... Kimura-Hayama ET, Higuera JA, Corona-Cedillo R, Chávez-. Macías L, Perochena A, ...
Machado LR, NÃ³brega JPS, Barros NG, Livramento JA, Bacheschi LA, Spina-FranÃ§a A. Computed tomography in neurocysticercosis: a 10-year evolution analysis of 100 patients with an appraisal of a new classification. Arq Neuropsiquiatr 1990; 48:414-418.
Metode mutakhir, dosis dan hasil pengobatan medik taeniasis/sistiserkosis, penyakit zoo-parasitik yang disebabkan Taenia solium dan Taenia saginata dibahas. Pada kasus sistiserkosis T. solium, khususnya neurosistiserkosis waktu optimal dan dosis untu
4Institute for Creative Technologies, University of Southern California, Los Angeles, California. 5Emory .... II (BDI),20â24 Beck Anxiety Inventory (BAI),25. CAGE ...
May 5, 2016 - Cerebral vein thrombosis (CVT) is a relatively uncommon type of stroke accounting for about 0.5% to 1% of all strokes [1,2]. The clinical presentation of CVT is highly variable and ranges from mild or non-specific symptoms of raised int
acids and free radicals, during cerebral ischemia.1 In animal models of ... IH-2 Responds with minimal movement such as decerebrate and decorticate posturing.
normal CT scan but 2 or more the following criteria: age .... (considering insensible losses) to sustain a state ..... (such as osmotherapy or hemicraniectomy).
or angiitis,6 and drug-induced cerebral arteritis or angiopathy.7,8. We report a case of pseudoephedrine-associated severe. RCVS in which the patient ...
Cerebral cysticercosis by Taenia crassiceps was diagnosed in an adult .... their feces (taeniasis). ... logical or molecular criteria.13,18 Tapeworm cysts in the.
Cysticercosis is the most common parasitic disease worldwide; with an estimated prevalence greater than 50 million persons are infected. The life cycle of the pork tapeworm, Taenia solium, begins at the larval stage in pigs. Human tapeworm infection
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Nov 14, 2013 - might provide an additional, highly specific tool in NCC diagnosis. Citation: ... highly sensitive and specific for the identification of taeniasis.
significance of subcutaneous Cysticercosis is that it may indicate the central nervous system ... We report 2 cases of subcutaneous. Cysticercosis. ... of parasite appearing as rounded wavy folds and ... Gupta S, Jain VK, Sen J, Gupta S, Arora B:.
Aug 17, 2016 - ous internal carotid artery (ICA) aneurysm that was treated with a flow ... from the petrous to the superior hypophyseal segments of the ICA.17.
Cerebral aneurysms diagnosed during pregnan- cy, after acute subarachnoid hemorrhage or acute enlargement, are a rare cause of morbidity and mortality. The prevalence of intracranial hemor- rhage during pregnancy ranges from 0.01% to. 0.05% (1â5),
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Jan 2, 2014 - Citation: Feliciano CE, Rayo E, Mendoza J, RodrÃguez-Mercado R (2014). Endovascular Treatment of Cerebral Arteriovenous Malformations.
Apr 1, 2016 - The diagnosis of subcutaneous cysticercosis was made. Orthopaedic .... Y, et al. (2013) Rare case of disseminated cysticercosis and taeniasis.
Apr 20, 2018 - Human taeniasis/cysticercosis: a potentially emerging parasitic disease in .... For many years, the diagnosis of taeniasis has been based.
immunosorbent) assay or EITB (enzyme-linked immunoelectrotransfer blot)4, but it is important to consider that individuals living in an endemic area may have ...
Oct 30, 2016 - nosis of patients with cerebral infarction (CI), but information is limited concerning dosing ... Stem cells have the capability to self-replicate.
Arq Neuropsiquiatr 2008;66(1):114-116
TREATMENT OF CEREBRAL CYSTICERCOSIS WITH ALBENDAZOLE IN ELEVATED DOSAGES Marco Antônio Rocha Jr1, Juliana Machado Santiago dos Santos2, Elisa Conci de Souza Gomes2, Marco Antônio Rocha3, Cristiane Franklin Rocha4, Gervásio Teles Cardoso de Carvalho5, Bruno Silva Costa6 Neurocysticercosis is the most common parasitic infection of the central nervous system (CNS)1-3. It has been estimated that 50 million people in the underdeveloped countries are infected and the disease is endemic to Latin America (Equatorial Zone and Brazil), Mexico, Central America, Asia and Africa1,4. Because it is a transmissible disease its high incidence reflects the bad conditions of the local basic sanitation2. Neurocysticercosis treatment is still surrounded by doubts. The decision about whether to have a clinical or a surgical treatment is, most of the times, very difficult, especially when the location is ventricular or subarachnoidal5. Whenever the clinical treatment is chosen the doubts still remain, regarding the cysticide dosage and the time of the treatment. The case we report is illustrative in this way. CASE A 38 years old woman was carrier of racemose cysticercosis with cysticercus in different stages, located in the cisterna and in the parenchyma, since 1996 (Fig 1A). History of seizures, which have been controlled by antiepileptic drugs. In 1999, the patient developed cysts in the quadrigeminal cisterna, with supratentorial dilatation of the ventricular system, without symptoms of intracranial hypertension (Fig 1B). The patient evolved in an asymptomatic way, despite the growing cysts inside the quadrigeminal cisterna, which were evident in a cranial computed tomography (CT) in 2001 (Fig 1C). In September 2004, the lesion in the quadrigemial cisterna disappeared (Figs 1D and 1E). There are no known documents or reliable reports about the use of cysticides during this time. In October 2005, the patient developed right eyelid ptosis. The magnetic resonance imaging (MRI) revealed cistyc lesions, which suggested cisternal cysticercosis in the suprasellar and perimesencephalic region on the right side. The third cra-
nial nerve was compromised, in association with communicant hydrocephaly. In December 2005, the patient was admitted at SEMPER hospital prostrated, with headache and vomiting. CT revealed an increase in the cistyc lesion of the prepontin cisterna and a discret increase of the hydrocephaly regarding previous studies (Figs 2A, 2B). The patient was submitted to ventriculoperitoneal shunt and the symptoms were solved (Fig 2C). However, the oculomotor paralysis persisted on the right side. During this hospitalization, the patient was also submitted to a treatment with albendazole 15 mg/Kg for 8 days. In January 30th 2006, the patient was readmitted with paralysis of the right third nerve and left hemiparesis. MRI revealed a resolution of the hydrochepaly and an increase on the size of the lesion in the prepontine cisterna, with a significant compression of the mesencephalous, which justified the alternate syndrome (Fig 2D and 2E). Also, there is still presence of bilateral chronic subdural hematoma, bigger at right, which was probably a consequence of the shunt (Fig 2F). The patient went through surgical drainage of the hematoma but there was no improvement of the hemiparesis and ptosis. The ventricular cateter was not removed. A new therapeutic treatment was accomplished using albendazole 30 mg/Kg dose, for 30 days, along with dexamethasone IV during the first week of treatment. The patient was discharged and completed the treatment at home, with oral corticoids in a decreasing way. Control CT after 15 days of treatment showed a resolution of the subdural hematoma, but also the persistence of the lesion in the cistern (Figs 3-A and 3-B). The patient’s neurological deficits did not change. After the therapeutic treatment was finished, the patient returned with significant improvement of the hemiparesis and ptosis. No side effects were noticed during this time. A CT scan, 60 days after the beginning of the treatment, revealed a decrease in the size of the cyst of the basal cistern, and totally recovery of the focal deficits (Fig 3C).
Tratamento de cisticercose cerebral com albendazol em doses elevadas 1
Professor of Neuroanatomy and Neurology at Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte MG, Brazil (FCMMG), Professor of Neurology at PUC/MG, Neurosurgeon at SEMPER and Vera Cruz Hospitals, Belo Horizonte MG, Brazil; 2Undergraduating in Medicine, Neuroanatomy monitor at FCMMG; 3Professor of Neuroanatomy and Neurology at FCMMG, Chief of the Neurosurgery Service at SEMPER Hospital, Belo Horizonte MG, Brazil; 4Professor of Neurology at FCMMG, Neurologist at SEMPER Hospital, Belo Horizonte MG, Brazil; 5Professor of Neurosurgery at FCMMG, Neurosurgeon at Santa Casa, Belo Horizonte MG, Brazil; 6Neurosurgeon at Santa Casa, Belo Horizonte MG, Brazil. Received 11 May 2007, received in final form 22 November 2007. Accepted 4 January 2008. Dr. Marco Antônio Rocha Jr – Rua Helena Abdalla 25 / 703 - 30380-550 Belo Horizonte MG - Brasil. E-mail: [email protected] 114
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Cerebral cysticercosis treatment: albendazole Rocha Jr et al.
Fig 1. (A) Cranial CT showing lesions of cerebral cysticercosis; (B and C) Cranial CT showing cyst in the quadrigeminal cistern and dilatation of the ventricular system; (D and E) Cranial CT showing the disappearing of the cyst in the quadrigeminal cistern.
Fig 2. (A) MR of the encephalous revealing cistyc lesions in the suprasellar and perimesencephalic region on the right side; (B) Cranial CT revealed an increase in the cistyc lesion of the prepontin cistern; (C) Cranial CT with intraventricular cateter; (D and E) MR of the encephalous revealing a resolution of the hydrocephaly and an increase on the size of the lesion in the prepontin cistern; (F) MR of the encephalous revealing bilateral chronic subdural hematoma.
Fig 3. (A and B) Cranial CT after 15 days of treatment with Albendazole (30 mg/Kg) shows a resolution of the subdural hematoma, but also the persistence of the lesion in the cistern; (C) CT scan, 60 days after the beginning of the treatment with Albendazole, revealing a decrease in the size of the cyst of the basal cistern; (D) Within 6 months of evolution the CT shows a almost completely resolution of the lesion caused by neurocysticercosis.
Within 6 months of follow-up, the patient presented no neurological deficits, and the CT showed almost completely resolution of the lesion caused by neurocysticercosis (Fig 3D).
DISCUSSION Most people with cyticercosis are assymptomatic.
Their clinical manifestation depends on the location, size and number of cysts and on the host’s immune response to the parasite1. Seizures appear in 70% to 90% of the patients1. Intracranial hypertension, headache, meningeal syndrome and psychiatric disturbs are other recurrent manifestations6. 115
Cerebral cysticercosis treatment: albendazole Rocha Jr et al.
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The hexacanth embryo reaches the CNS, via the vascular system. It passes through the capillar wall in the encephalic parenchyma, develops into the cystic form and then turns into Cisticercus celullosae, a benign form of the disease2,5. In this period, it shows a thin membrane with a colorless liquid in the inside associated with the scolex.
albendazole still remains unclear3. Other authors recommended the treatment with albendazole for 28 to 30 days and that can reach even 60 days of treatment1,4,5. Controversy arises also over the dose of treatment. Recently studies have been made regarding the treatment of racemose neurocysticercosis with elevated dosages of albendazole.
The cysticercus which develop inside the ventricle and subarachnoidal space assumes the Cisticercus racemosus form, a malign form of the disease, wich is characterized by an irregular enhance membrane, absence of scolex and grouped in multiples vesicles2. Hydrocephaly is the most common manifestation. The prognosis is bad, and the therapeutic response is low, poor and the life span is short.
Comparative studies between the treatment of subarachnoidal and intraventricular forms of the parasite with a 15 and a 30 mg dose of albendazole, had shown an involution of the cysticercus much more significant in the groups treated with higher doses of the cysticid5,8,9. In our patient we used 30 mg/Kg dose, for 30 days.
In the CNS, the cysticercus shows a natural evolutive process that culminates in its degeneration in an approximated time of 2 to 5 years2. During this period, they go through 4 stages7: (1) vesicular: active form, with an albescent membrane, translucent, with colorless liquid and the scolex in the inside; (2) colloidal: there is an enhancing membrane e substitution from the lipid liquid by an albescent gel; (3) granular: calcium is deposited in the gel; (4) nodular: there is a completely calcification of the cyst. Treatment of neurocysticercosis may be clinical or surgical. Surgical treatment is traditionally recommended for the intracranial forms which improve with local compression of the encephalous and cranial nerves or intracranial hypertension. The effectiveness of the surgical procedure to remove the cistycercus from the cisterna of the base is doubtful2. Ordinarily, cistycercus are multiple and show a partial degeneration as well as adherence to the cranial nerves, vessels and encephalic parenchyma because of arachnoiditis, meaning that an attempt to completed lysis can be disastrous2. When a choice must be made between a surgical or a pharmacological conduct, there is still much controversy, especially if the location of the cyst is at the ventricular or subarachnoidal space. The conduct must be individualized for each case5. Because these considerations, we choose to try the clinical treatment of the reported patient. Albendazole has been used in a 15 mg/Kg dose for 15 days and more recently for 8 days2. Singhi3, in a prospective, randomized, double blind study with 122 children with neurocysticercosis, treated half of the patients with albendazole (15 mg/Kg) for 7 days and the other group was treated with the same drug and the same dosage for 4 weeks. He came to the conclusion that the 1 week treatment was as effective as the treatment for 28 days. The exactly time of the terapy with
It seems to be consensual as well as in our reported case, the treatment among with corticoid therapy (dexamethasone)1,2,4,8. Predisone may be employed when a longterm treatment is needed, especially in cases of chronic arachnoiditis. For the intracranial hypertension, manitol would be indicated as well. Some authors recommended antihistaminics instead of dexametasone, and this is also useful in diabetes and blood hypertension5,9. Elevated dosage of albendazole does not seem to be associated to the increase of side effects when compared with the usual doses5,8,9. In conclusion, administration of elevated dosages of albendazole has been shown to be more effective and free from the side effects when compared to the treatment with conventional dosages. Clinical follow-up for longer periods seems to be necessary. The need of repeated cycles of the treatment is still questioned by some authors. REFERENCES 1. Cerdas C, Retana M, Ramírez G, Valenciano A. Neurocisticercosis parenquimatosa activa: reporte de um caso y revisión de la literatura. Rev Costorricense 2004;25:41-47. 2. Colli BO, Carlotti CGJr. Fisiopatologia, diagnóstico e tratamento da cisticercose do sistema nervoso central. Temas atuais de neurocirurgia: cisticercose do SNC, Sociedade de Neurocirurgia do Estado de São Paulo 2003;4-19. 3. Singhi P, Dayal D. One week versus four weeks of albendazole therapy for neurocysticercosis in children: a randomized, placebo-controlled double blind tiral. Pediatr Infect J 2003;22:268-272. 4. Kalra V, Dua T, Kumar V. Efficacy of albendazole and short-course dexamethasone treatment in children with 1 or 2 ring-enhancing lesions of neurocysticercosis: a randomized controlled trial. J Pediatr 2003;143:111-114. 5. Agapejev S, Silva MD, Ueda AK. Severe forms of neurocysticercosis: treatment with albendazole. Arq Neuropsiquiatr 1996;54:82-93. 6. Souza SEM. Neurocisticercose. In: Souza SEM (Ed). Tratamento das doenças neurológicas. Rio de Janeiro: Guanabara Koogan,2000:13-15. 7. Machado LR, Nobrega JP, Barros NG, Livramento JA, Bacheschi LA, Spina-França A. Computed tomography in neurocysticercosis: a 10year long evolution analysis of 100 patients with an appraisal of a new classification. Arq Neuropsiquiatr 1990;48:414-418. 8. Rivera G, Hernández S, González ED, et al. Albendazole trial at 15 or 30 mg/Kg/day for subarachnoid and intraventricular cysticercosis. Neurology 2006;66:436-438. 9. Agapejev S, Meira DA, Barravieira B, et al. Neurocysticercosis: treatment with albendazole and dextrochloropheniramine. Trans R Soc Trop Med Hyg 1989;83:377-383.