Quistes subaracnoideos gigantes por neurocisticercosis: a propósito de dos casos observados en un área rural de Extremadura

Abstract

Neurocysticercosis is the commonest cerebral parasitosis. The most recent cases reported in Spain have occurred in patients from endemic countries. The formation of giant subarachnoid cysts (GSC) is an uncommon complication of neurocysticercosis and its treatment is the subject of debate. We report two cases seen recently in the Valle del Jerte, a rural district in Extremadura. Case 1. A 64 year old man had had complex partial crises (CPC) since 1985. In 1987 he was diagnosed as having neurocysticercosis with parenchymatous cysts and treated with praziquantel. In 1996, on CAT and MR a left frontal GSC was diagnosed and also two parenchymatous active cysts. The cyst was removed surgically and he was subsequently treated with albendazol. Case 2. A 72 year old man had generalized crises and CPC since 1970. In 1987 and 1991 on CAT and MR several parenchymatous lesions compatible with neurocysticercosis were seen. In 1997 he presented with headache and subacute cognitive impairment. On CAT and MR a left temporal GSC was seen with several active parenchymatous lesions. The patient was treated with albendazol and dexamethasone. Both patients improved, although radiological resolution of the GSC in case 2 took a year. Neurocysticercosis is a condition still present in Spain. GSC respond to treatment with albendazol, whilst surgical treatment is the best option when severe intracranial hypertension occurs.