Abstract
.Ventricular involvement in neurocysticercosis (NCC), a common serious manifestation of NCC, has distinct clinical presentations, complications, and treatments primarily because of partial or complete obstruction of the cerebrospinal fluid (CSF) flow by Taenia solium cysts. We review the clinical course, treatments, and long-term outcomes in 23 of 121 (19.0%) total NCC patients with ventricular cysts referred to the National Institutes of Health from 1985 to the October 2017. Patients had a median age of 31.8 (range: 22.4–52.6 years), were 60.9% male, diagnosed a median of 6.5 years (range: 0.17–16 years) after immigration, and were followed for a median of 3.6 years (range: 0.1–30.5 years). Other forms and manifestations of NCC were present in 73.9% (17/23). The fourth ventricle was involved in a majority (15/23, 65.2%) resulting in hydrocephalus (73.9%), ventriculitis, and periventricular edema (7/23, 30.4%). Cystectomy was accomplished in 60.9%, usually by removal of a fourth ventricular cyst through a suboccipital craniotomy. Nonresectable cysts were treated medically. Ventriculoperitoneal shunts were inserted in 43.5% (10/23) and failed in four, three from infection. Other complications included surgically induced injuries (4/23, 17.4%) and entrapment of a lateral ventricle (2/23, 8.7%). Despite a common severe early course, 90.9% (20/22) stabilized without recurrence, 15% (3/20) complained of mild-to-moderate neurological complaints, and 15% (3/20) were significantly disabled. Four patients who underwent removal of ventricular cysts without significant other NCC and who received with no cysticidal treatment became CSF cestode antigen negative without recurrence indicating that after successful extraction of cysts, additional cysticidal treatment may not be needed.
Highlights
Neurocysticercosis (NCC) is caused by infection of the brain by larval cyst of the tapeworm Taenia solium
The clinical presentation of ventricular NCC is relatively specific because symptoms are primarily because of acute and/or chronic obstruction of cerebrospinal fluid (CSF) flow and associated inflammation, usually centered in and around the fourth ventricle
Other forms of NCC frequently occurred in the presence of ventricular disease; parenchymal calcifications was most common other involvement followed by subarachnoid disease, similar to the high occurrence noted by Mexican investigators.[17]
Summary
Neurocysticercosis (NCC) is caused by infection of the brain by larval cyst of the tapeworm Taenia solium. Clinical manifestations are variable, dictated by the parasite burden, location of the cysts, presence and degree of parasite degradation, and associated level of inflammation. Cysts located in the parenchymal, subarachnoid, and ventricular compartments of the brain tend to give rise to distinct clinical presentations that require specific surgical and/or medical approaches and therapies. Cysts in the subarachnoid space give rise to symptoms related to mass effects and chronic arachnoiditis resulting in infarcts, nerve entrapments, and hydrocephalus.[1] Manifestations of ventricular cysts are primarily because of complete, partial, or transient obstruction of cerebrospinal fluid (CSF) flow caused by obstructing or migrating cysts and associated ventriculitis.[2,3,4] Unattached cysts may cause acute or episodic symptoms from transient obstruction, sometimes from head movement (Bruns syndrome).[5] Degenerating cysts are commonly attached to the ependymal lining of the ventricles frequently causing acute or chronic ventriculitis,[6,7] partial or complete obstruction of CSF flow, hydrocephalus, periventricular inflammation, and in the most severe form, a locked-in ventricle leading to herniation, if untreated.[8,9]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: The American Journal of Tropical Medicine and Hygiene
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
