title: Edema surrounding calcified intracranial cysticerci: clinical manifestations, natural history, and treatment.
abstract: Calcified granulomas are the most common radiological finding in neurocysticercosis (10-20% of endemic populations). A small proportion serves as foci of seizure activity, which results in large numbers of persons with epilepsy. Calcified granulomas are not all the same. Some  demonstrate blood-brain barrier dysfunction (magnetic resonance imaging enhancement) most likely due to the presence of inflammation, visualizable scolices, and/or gliosis. About half the patients with a recent history of seizures, positive serology, and only calcified lesions develop  perilesional edema at the time of a seizure recurrence. The natural history, treatment, and pathophysiology of this phenomenon are not well studied. Episodes are usually associated with seizures or other neurological manifestations, resolve by 4-6 weeks, sometimes occur repeatedly,  and usually involve a subset of the same calcifications. Treatment is supportive. Histopathological examination of one calcification associated with multiple perilesional edema episodes revealed significant inflammation and supports the concept that perilesional edema is inflammatory in nature.  This most likely is due to host responses to released or newly recognized parasite antigen and/or upregulation of the host immune response. Immunosuppressive and anti-inflammatory agents may be useful in prevention and/or treatment of this phenomenon.
authors.affiliation: Laboratory of Parasitic Diseases, National Institues of Health, National Institutes of Allergy and Infectious Diseases, Bethesda, MD 20892, USA. tnash@niaid.nih.gov
authors.forename: Theodore
authors.initials: T
authors.lastname: Nash
mesh_terms: D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001929:Brain Edema / Q000209:etiology / Q000473:pathology*; D002114:Calcinosis; D003552:Cysticercus / Q000502:physiology*; D004827:Epilepsy / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D020019:Neurocysticercosis / Q000150:complications / Q000188:drug therapy / Q000473:pathology*
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents