Cefalea en un paciente joven: Neurocisticercosis

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Abstract

La cisticercosis cerebral es una forma de presentación de parasitosis cerebral causada por Tenia Soleum. A pesar de la escasa prevalencia lejos de las zonas endémicas, el incremento de los movimientos migratorios obliga a un mayor estado de alerta por parte del médico ante síntomas frecuentes como es una cefalea, sobre todo en pacientes con factores de riesgo epidemiológicos. El diagnóstico debe ser precoz y el tratamiento instaurarse lo antes posible, de lo contrario las consecuencias pueden ser fatales para el enfermo.

Translated abstract

The cerebral neurocysticercosis is a form of presentation of parasitosis caused by Taenia Soleum. In spite of low prevalence far from endemic areas, the migratory movements increment forces to bigger alert by the doctor because of frecuent syntoms as a migraine, mainly in patient with epidemic risk factors. The diagnosis should be accurate and the treatment must be established as soon as possible, otherwise the consequences can be fatal for the patient.

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Most cited references 45

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Proposed diagnostic criteria for neurocysticercosis.

V Rajshekhar, Stimson P Schantz, O Del Maschio … (2001)

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.

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Neurocysticercosis as the main cause of late-onset epilepsy in Mexico.

Marco Medina (1990)

We studied 100 consecutive Mexican patients with epilepsy that started after the age of 25 years. All patients underwent clinical evaluation, computed tomography, and electroencephalography; additionally, cerebrospinal fluid analysis was performed in 82 of them. Neurocysticercosis or its sequelae were diagnosed in 50 patients (50%); 36 of these patients had partial seizures, 41 had parenchymal calcifications, and 15 had two or more lesions. Our results are in contrast with those of most studies from countries with a low incidence of neurocysticercosis, where brain tumors, cerebrovascular disease, trauma, and alcoholism are the main causes of tardive epilepsy.

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Medical treatment for neurocysticercosis characterized by giant subarachnoid cysts.

J Proaño, I Madrazo, Gleide Avelar … (2001)

Infection with the larval form of the pork tapeworm, Taenia solium, can lead to the development of cysts in the brain. Surgical removal of cysts has been the accepted treatment for neurocysticercosis characterized by giant cysts when there is associated intracranial hypertension. We describe 33 patients whom we treated medically for malignant forms of neurocysticercosis. All patients had evidence of intracranial hypertension and subarachnoid cysts at least 50 mm in diameter. All patients received 15 mg of albendazole per kilogram of body weight per day for four weeks. Ten patients were also treated with 100 mg of praziquantel per kilogram per day for four weeks. Seventeen patients received a second course of albendazole, three received a third course, and one received a fourth course. During the first cycle of treatment, all patients also received dexamethasone. Five patients had previously undergone neurosurgery for giant cysts. After a median of 59 months of follow-up (range, 7 to 102), the condition of all 33 patients had improved, and the cysts had disappeared or become calcified. Of the 22 patients with a history of seizures, only 11 continued to receive antiseizure medications. The median quality-of-life score on the Karnofsky scale improved from 40 to 100. Fifteen patients received a ventriculoperitoneal shunt because of hydrocephalus. Four patients had persistent sequelae (bilateral partial optic atrophy, stroke, or diplopia) of the cysts. Intensive medical treatment can be effective in patients with neurocysticercosis characterized by giant cysts. Neurosurgery may be required only when there is an imminent risk of death.

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Author and article information

Contributors

R. Romero Pareja: Role: ND

B. García Lecuona: Role: ND

J. A. Ferrús Ciriza: Role: ND

Journal

Journal ID (publisher): medif

Title: Medifam

Abbreviated Title: Medifam

Publisher: Arán Ediciones, S. L. (Madrid )

ISSN: 1131-5768

Publication date (Print): December 2002

Volume: 12

Issue: 10

Pages: 68-76

Affiliations

[1 ] Área 1

[2 ] Hospital General Universitario Gregorio Marañón Spain

Article

Publisher ID: S1131-57682002001000007

DOI: 10.4321/s1131-57682002001000007

SO-VID: 99594836-78b4-45e6-9f82-56d61dfd4ff9

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http://creativecommons.org/licenses/by/4.0/

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SciELO Spain

Self URI (journal page): http://scielo.isciii.es/scielo.php?script=sci_serial&pid=1131-5768&lng=en

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Cefalea en un paciente joven: Neurocisticercosis Translated title: Migraine in a young patient: Neurocysticercosis

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Most cited references 45

Proposed diagnostic criteria for neurocysticercosis.

Neurocysticercosis as the main cause of late-onset epilepsy in Mexico.

Medical treatment for neurocysticercosis characterized by giant subarachnoid cysts.

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