Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.
Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.
Neurol India. 2022 May-Jun;70(3):1032-1040. doi: 10.4103/0028-3886.349634.
Neurocysticercosis (NCC) due to Taenia Solium is a major public health problem. Our objective was to study patients with disseminated cysticercosis (DCC) who had NCC in the brain along with an additional site in the body and assess their clinical, radiological profile, and response to therapy.
A chart review of DCC with a high lesion load of NCC ≥20 (DNCC) in the brain was performed.
Sixteen (M:F = 13:3) patients were diagnosed with DNCC with a mean age of presentation of 35.1 ± 14.2 years. Headache was the predominant symptom, followed by seizures (93.75%), vomiting (43.75%), behavioral disturbances (31.25%), fever (12.5%), encephalopathy (12.5%), visual disturbances (6.25%), and muscle pain and limb weakness (6.25%). CT brain showed multiple active parenchymal cysts in all, and calcifications in 68.75%. MRI brain revealed involvement of cortex and subcortical structures in all, followed by cerebellum (81.25%) and brainstem (75%). Intramedullary spinal lesion was observed in 12.5% cases. Albendazole with steroids was used in 15 patients. In 93.3% patients, there was complete improvement in seizures; 12.5% subjects had persistent memory and behavioral abnormalities. One subject required decompressive craniectomy; mortality was observed in two subjects.
We hereby report one of the largest case series on disseminated cysticercosis with a high lesion load of NCC in the brain. A comprehensive clinical, imaging, therapeutic response with repeat imaging and long-term follow-up has given us a better understanding of this difficult-to-treat neurological disorder. We suggest cautious use of anti-parasitic therapy under the cover of corticosteroids to prevent irreversible neurological sequelae.
由猪带绦虫引起的神经囊尾蚴病（NCC）是一个主要的公共卫生问题。我们的目的是研究伴有脑内多发囊虫病（DCC）且在体内其他部位有 NCC 的患者，并评估其临床、影像学特征及治疗反应。
对脑内 NCC 病变负荷≥20 个（DNCC）的 DCC 患者进行病例回顾。
共诊断出 16 例（男：女=13：3）DNCC 患者，中位发病年龄为 35.1±14.2 岁。头痛是最常见的症状，其次是癫痫（93.75%）、呕吐（43.75%）、行为障碍（31.25%）、发热（12.5%）、脑病（12.5%）、视力障碍（6.25%）、肌肉疼痛和肢体无力（6.25%）。头颅 CT 显示所有患者均有多发性脑实质囊肿，68.75%的患者有钙化。头颅 MRI 显示所有患者均有皮层及皮质下结构受累，其次是小脑（81.25%）和脑干（75%）受累。12.5%的患者有脊髓内病变。15 例患者使用阿苯达唑联合激素治疗。93.3%的患者癫痫完全缓解，12.5%的患者有持续的记忆和行为异常。1 例患者需行减压性颅骨切除术，2 例患者死亡。
我们报告了脑内多发囊尾蚴病且伴有大量 NCC 的病例系列之一。全面的临床、影像学、治疗反应以及重复影像学检查和长期随访使我们对这种难以治疗的神经疾病有了更好的理解。我们建议在皮质激素覆盖下谨慎使用抗寄生虫治疗，以防止不可逆的神经后遗症。
