Clinical Symptoms, Imaging Features and Cyst Distribution in the Cerebrospinal Fluid Compartments in Patients with Extraparenchymal Neurocysticercosis.
Extraparenchymal neurocysticercosis has an aggressive course because cysts in the cerebrospinal fluid compartments induce acute inflammatory reactions. The relationships between symptoms, imaging findings, lesion type and location remain poorly understood. In this retrospective clinical records-based study, we describe the clinical symptoms, magnetic resonance imaging features, and cyst distribution in the CSF compartments of 36 patients with extraparenchymal neurocysticercosis. Patients were recruited between 1995 and 2010 and median follow up was 38 months. During all the follow up time we found that 75% (27/36) of the patients had symptoms related to raised intracranial pressure sometime, 72.2% (26/36) cysticercotic meningitis, 61.1% (22/36) seizures, and 50.0% (18/36) headaches unrelated to intracranial pressure. Regarding lesion types, 77.8% (28/36) of patients presented with grape-like cysts, 22.2% (8/36) giant cysts, and 61.1% (22/36) contrast-enhancing lesions. Hydrocephalus occurred in 72.2% (26/36) of patients during the follow-up period. All patients had cysts in the subarachnoid space and 41.7% (15/36) had at least one cyst in some ventricle. Cysts were predominantly located in the posterior fossa (31 patients) and supratentorial basal cisterns (19 patients). The fourth ventricle was the main compromised ventricle (10 patients). Spinal cysts were more frequent than previously reported (11.1%, 4/36). Our findings are useful for both diagnosis and treatment selection in patients with neurocysticercosis.
Department of Neurology, Psychology and Psychiatry from Botucatu Medical School; Univ Estadual Paulista. Botucatu, Brazil.
Rodrigo
R
Bazan
Department of Neurology, Psychology and Psychiatry from Botucatu Medical School; Univ Estadual Paulista. Botucatu, Brazil.
Pedro Tadao
0000-0001-6436-9307
PT
Hamamoto Filho
Department of Neurology, Psychology and Psychiatry from Botucatu Medical School; Univ Estadual Paulista. Botucatu, Brazil.
Gustavo José
GJ
Luvizutto
Department of Neurology, Psychology and Psychiatry from Botucatu Medical School; Univ Estadual Paulista. Botucatu, Brazil.
Hélio Rubens de Carvalho
HR
Nunes
Department of Neurosciences and Behavioral Sciences from Ribeirão Preto School of Medicine; Univ São Paulo. Ribeirão Preto, Brazil.
Newton Satoru
NS
Odashima
Department of Internal Medicine from Ribeirão Preto School of Medicine; Univ São Paulo. Ribeirão Preto, Brazil.
Antônio Carlos
AC
Dos Santos
Department of Internal Medicine from Ribeirão Preto School of Medicine; Univ São Paulo. Ribeirão Preto, Brazil.
Jorge
J
Elias Júnior
Department of Neurology, Psychology and Psychiatry from Botucatu Medical School; Univ Estadual Paulista. Botucatu, Brazil.
Marco Antônio
MA
Zanini
Institute for Biomedical Investigation; Universidad Nacional Autónoma de Mexico. Mexico City, Mexico.
Agnès
A
Fleury
Department of Neurosciences and Behavioral Sciences from Ribeirão Preto School of Medicine; Univ São Paulo. Ribeirão Preto, Brazil.
Osvaldo Massaiti
OM
Takayanagui
D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging*; D002555:Cerebrospinal Fluid / Q000000981:diagnostic imaging*; D003560:Cysts / Q000134:cerebrospinal fluid*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020019:Neurocysticercosis / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D055815:Young Adult