1
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Gupta S, Gupta S, Sharma R, Ghosh S, Kumar J, Jha A. Imaging findings of orofacial cysticercosis: report of 5 cases with review of literature. Oral Radiol 2024; 40:81-91. [PMID: 36066814 DOI: 10.1007/s11282-022-00651-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/25/2022] [Indexed: 11/25/2022]
Abstract
Cysticercosis, a fatal disease of parasitic aetiology seen in humans, is caused by ingestion of larvae of Taenia solium in form of raw or poorly cooked pork. Commonly seen in developing countries, it affects the brain, muscle, lungs, heart and liver and is rarely found in the maxillofacial region. Sometimes, the only evidence of cysticercosis could be the cystic swellings or nodules in the maxillofacial region. Such solitary clinical presentation can be diagnosed early with the aid of ultrasound (USG) and Magnetic resonance imaging (MRI). Here, we present 5 cases of intramuscular cysticercosis of Orofacial region which were initially diagnosed on ultrasonography and later confirmed by MRI and aspiration cytology. We have conducted a systematic review of PubMed Literature for Intramuscular cysticercosis of orofacial region and highlighted key imaging findings from 18 cases retrieved. Through this case series, we highlight the USG and MRI imaging features of intramuscular cysticercosis which are characteristic and diagnostic of the condition.
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Affiliation(s)
- Shikha Gupta
- Oral Medicine & Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India.
| | - Sunita Gupta
- Oral Medicine & Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Ridam Sharma
- Oral Medicine & Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Sujoy Ghosh
- Oral Medicine & Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Jyoti Kumar
- Department of Radio-Diagnosis, Maulana Azad Medical College, New Delhi, India
| | - Abhishek Jha
- Oral Medicine & Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
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2
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Nóbrega PR, R. B. de Paiva A, Souza KS, de Souza JLB, G. S. B. Lima PL, da Silva DJ, Pitombeira MS, Borges VK, Dias DA, Bispo LM, Santos CF, Freua F, Silva PDS, Alves IS, Portella LB, Cunha PR, Salomao RPA, Pedroso JL, Miyajima VP, Miyajima F, Cali E, Wade C, Sudarsanam A, O’Driscoll M, Hayton T, Barsottini OGP, Klebe S, Kok F, Lucato LT, Houlden H, Depienne C, Lynch DS, Braga-Neto P. Expanding the phenotypic spectrum of CLCN2-related leucoencephalopathy and ataxia. Brain Commun 2023; 6:fcad273. [PMID: 38173802 PMCID: PMC10763528 DOI: 10.1093/braincomms/fcad273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/13/2023] [Accepted: 10/16/2023] [Indexed: 01/05/2024] Open
Abstract
Mutations in CLCN2 are a rare cause of autosomal recessive leucoencephalopathy with ataxia and specific imaging abnormalities. Very few cases have been reported to date. Here, we describe the clinical and imaging phenotype of 12 additional CLCN2 patients and expand the known phenotypic spectrum of this disorder. Informed consent was obtained for all patients. Patients underwent either whole-exome sequencing or focused/panel-based sequencing to identify variants. Twelve patients with biallelic CLCN2 variants are described. This includes three novel likely pathogenic missense variants. All patients demonstrated typical MRI changes, including hyperintensity on T2-weighted images in the posterior limbs of the internal capsules, midbrain cerebral peduncles, middle cerebellar peduncles and cerebral white matter. Clinical features included a variable combination of ataxia, headache, spasticity, seizures and other symptoms with a broad range of age of onset. This report is now the largest case series of patients with CLCN2-related leucoencephalopathy and reinforces the finding that, although the imaging appearance is uniform, the phenotypic expression of this disorder is highly heterogeneous. Our findings expand the phenotypic spectrum of CLCN2-related leucoencephalopathy by adding prominent seizures, severe spastic paraplegia and developmental delay.
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Affiliation(s)
- Paulo R Nóbrega
- Division of Neurology, Department of Clinical Medicine, Federal University of Ceara, Fortaleza, Ceara 60430-160, Brazil
- Neurogenetics Unit, Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Anderson R. B. de Paiva
- Neurogenetics Unit, Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Sao Paulo 05403-000, Brazil
- Mendelics Genomic Analysis, Sao Paulo, Sao Paulo 02511-000, Brazil
- Department of Neurology, São Rafael Hospital, Rede D’Or São Luiz, Salvador, Bahia 41253-190, Brazil
| | - Katiane S Souza
- Neurogenetics Unit, Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Jorge Luiz B de Souza
- Center of Health Science, State University of Ceara, Fortaleza, Ceara 3101-9795, Brazil
| | | | | | - Milena Sales Pitombeira
- Hospital Geral de Fortaleza, Fortaleza, Ceara 60150-160, Brazil
- Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Viviennee K Borges
- Hospital de Clínicas, Universidade Federal de Uberlândia, Uberlandia, Minas Gerais 38405-320, Brazil
| | - Daniel A Dias
- Division of Radiology, Federal University of Ceara, Fortaleza, Ceara 60430-160, Brazil
| | - Luciana M Bispo
- Mendelics Genomic Analysis, Sao Paulo, Sao Paulo 02511-000, Brazil
- University Hospital, EBSERH/Federal University of Sergipe, Aracaju, Sergipe 49060-676, Brazil
| | - Carolina F Santos
- Universidade de Fortaleza, Fortaleza, Ceara 60811-905, Brazil
- Hospital Infantil Albert Sabin, Fortaleza, Ceara 60410-794, Brazil
| | - Fernando Freua
- Neurogenetics Unit, Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Sao Paulo 05403-000, Brazil
| | | | | | | | | | - Rubens Paulo A Salomao
- Ataxia Unit, Department of Neurology, Universidade Federal de São Paulo, Sao Paulo, Sao Paulo 04021-001, Brazil
| | - José Luiz Pedroso
- Ataxia Unit, Department of Neurology, Universidade Federal de São Paulo, Sao Paulo, Sao Paulo 04021-001, Brazil
| | - Veridiana P Miyajima
- Centre for Clinical Diagnostics, Haematology and Haemotherapy Centre of Ceara (HEMOCE), Fortaleza, Ceara 60416-130, Brazil
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 7BE, UK
| | - Fábio Miyajima
- Analytical Competence Molecular Epidemiology Lab (ACME), Oswaldo Cruz Foundation (Fiocruz), Fortaleza, Ceara 61773-270, Brazil
- Postgraduate Program in Medical Sciences, Federal University of Ceará (UFC), Fortaleza, Ceara 60020-181, Brazil
| | - Elisa Cali
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Charles Wade
- Queen Square MS Centre, UCL Institute of Neurology, London WC1N 3BG, UK
| | | | - Mary O’Driscoll
- West Midlands Regional Clinical Genetics Service, Birmingham Health Partners, Birmingham Women’s Hospital NHS Foundation Trust, Birmingham B15 2TG, UK
| | - Tom Hayton
- University Hospital Birmingham, Birmingham B15 2GW, UK
| | - Orlando G P Barsottini
- Ataxia Unit, Department of Neurology, Universidade Federal de São Paulo, Sao Paulo, Sao Paulo 04021-001, Brazil
| | - Stephan Klebe
- Department of Neurology, University of Würzburg, Essen 97080, Germany
| | - Fernando Kok
- Neurogenetics Unit, Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Sao Paulo 05403-000, Brazil
- Mendelics Genomic Analysis, Sao Paulo, Sao Paulo 02511-000, Brazil
| | - Leandro Tavares Lucato
- Neuroradiology Section, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo,Sao Paulo, Sao Paulo 05403-010, Brazil
- Grupo Fleury, São Paulo, São Paulo 01333-011, Brazil
| | - Henry Houlden
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
- National Hospital for Neurology & Neurosurgery, London WC1N 3BG, UK
| | - Christel Depienne
- Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen 45147, Germany
| | - David S Lynch
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
- National Hospital for Neurology & Neurosurgery, London WC1N 3BG, UK
| | - Pedro Braga-Neto
- Division of Neurology, Department of Clinical Medicine, Federal University of Ceara, Fortaleza, Ceara 60430-160, Brazil
- Center of Health Science, State University of Ceara, Fortaleza, Ceara 3101-9795, Brazil
- Postgraduate Program in Medical Sciences, Federal University of Ceará (UFC), Fortaleza, Ceara 60020-181, Brazil
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Mansour MA, Tahir M, Ahmadi Z. Neurocysticercosis presenting as a locked-in lateral ventricle: A case report and evidence-based review. IDCases 2023; 32:e01778. [PMID: 37324236 PMCID: PMC10267758 DOI: 10.1016/j.idcr.2023.e01778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 06/17/2023] Open
Abstract
Human neurocysticercosis is one of the most prevalent parasitic infestations of the central nervous system. It is considered the most frequent underlying etiology of acquired epilepsy in endemic areas in Central and South America, East Europe, Africa, and Asia, with over 50 million people affected globally. Ventricular involvement is a severe form of neurocysticercosis commonly manifests as arachnoiditis, raised intracranial pressure, or hydrocephalus, secondary to CSF flow obstruction of the ventricular system by cysts of Taenia solium, hence requiring prompt, aggressive intervention to alleviate the increased intracranial pressure to prevent imminent lethal complications. Ventricular neurocysticercosis can involve any brain ventricle but with a paramount preference for the fourth ventricle, causing non-communicating hydrocephalus and symmetric ventriculomegaly. However, in this clinical report, we present an uncommon case of trapped (locked-in) lateral ventricle caused by an isolated cysticercus trapped at the ipsilateral foramen of Monro, which is an atypical location for neurocysticercosis, adding more challenges to diagnosis and during the process of surgical extraction. We additionally provide a comprehensive, evidence-based review of the clinical course and management options relevant to the entity of ventricular neurocysticercosis, besides recent relevant clinical updates.
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Affiliation(s)
- Moustafa A. Mansour
- Department of Neurology and Neurologic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Department of Neurology and Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Division of Neuro-Intensive Care, Dar Al-Fouad Medical Corporation, Cairo, Egypt
- Department of Emergency Medicine and Critical Care, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Tahir
- Department of Emergency Medicine and Critical Care, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Zarina Ahmadi
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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4
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Ratcliffe C, Adan G, Marson A, Solomon T, Saini J, Sinha S, Keller SS. Neurocysticercosis-related Seizures: Imaging Biomarkers. Seizure 2023; 108:13-23. [PMID: 37060627 DOI: 10.1016/j.seizure.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
Neurocysticercosis (NCC)-a parasitic CNS infection endemic to developing nations-has been called the leading global cause of acquired epilepsy yet remains understudied. It is currently unknown why a large proportion of patients develop recurrent seizures, often following the presentation of acute seizures. Furthermore, the presentation of NCC is heterogenous and the features that predispose to the development of an epileptogenic state remain uncertain. Perilesional factors (such as oedema and gliosis) have been implicated in NCC-related ictogenesis, but the effects of cystic factors, including lesion load and location, seem not to play a role in the development of habitual epilepsy. In addition, the cytotoxic consequences of the cyst's degenerative stages are varied and the majority of research, relying on retrospective data, lacks the necessary specificity to distinguish between acute symptomatic and unprovoked seizures. Previous research has established that epileptogenesis can be the consequence of abnormal network connectivity, and some imaging studies have suggested that a causative link may exist between NCC and aberrant network organisation. In wider epilepsy research, network approaches have been widely adopted; studies benefiting predominantly from the rich, multimodal data provided by advanced MRI methods are at the forefront of the field. Quantitative MRI approaches have the potential to elucidate the lesser-understood epileptogenic mechanisms of NCC. This review will summarise the current understanding of the relationship between NCC and epilepsy, with a focus on MRI methodologies. In addition, network neuroscience approaches with putative value will be highlighted, drawing from current imaging trends in epilepsy research.
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Affiliation(s)
- Corey Ratcliffe
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India.
| | - Guleed Adan
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Anthony Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Tom Solomon
- The Walton Centre NHS Foundation Trust, Liverpool, UK; Veterinary and Ecological Sciences, National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, University of Liverpool, Liverpool, UK; Tropical and Infectious Diseases Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Jitender Saini
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Sanjib Sinha
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Simon S Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; The Walton Centre NHS Foundation Trust, Liverpool, UK
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5
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Vasconcelos Miranda TA, Tsuchiya K, Lucato LT. Imaging of Central Nervous System Parasitic Infections. Neuroimaging Clin N Am 2023; 33:125-146. [DOI: 10.1016/j.nic.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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6
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Uchôa LRA, Lucato LT. Newer Updates in Pediatric Intracranial Infection. Semin Roentgenol 2023; 58:88-109. [PMID: 36732014 DOI: 10.1053/j.ro.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/24/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Luiz Ricardo Araújo Uchôa
- Neuroradiology Section, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
| | - Leandro Tavares Lucato
- Neuroradiology Section, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil; Grupo Fleury, São Paulo, Brazil
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7
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Chawla S, Asadollahi S, Gupta PK, Nath K, Brem S, Mohan S. Advanced magnetic resonance imaging and spectroscopy in a case of neurocysticercosis from North America. Neuroradiol J 2022; 35:119-125. [PMID: 34167362 PMCID: PMC8826293 DOI: 10.1177/19714009211026889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Neurocysticercosis (NCC) is a parasitic infection caused by Cysticercus cellulosae, the metacestode of pork tapeworm (Taenia solium). NCC is one of the most common public health problems worldwide. We present a patient harboring a bilobed ring-enhancing lesion with a presumed diagnosis of brain metastasis, who returned to the USA after traveling to an endemic region. The diagnosis of NCC was established based on a characteristic resonance of succinate on proton magnetic resonance spectroscopy. Also, higher mean diffusivity and lower fractional anisotropy along with relative cerebral blood volume were observed from the lesion compared to contralateral normal brain regions. Multiparametric analysis may improve the differential diagnosis of ring-enhancing intracranial lesions such as NCC.
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Affiliation(s)
- Sanjeev Chawla
- Department of Radiology, Perelman School of
Medicine at the University of Pennsylvania, USA,Sanjeev Chawla, Department of Radiology, Division
of Neuroradiology, 219 Dulles Building, 3400 Spruce Street, Perelman School of Medicine at
the University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Shadi Asadollahi
- Department of Radiology, Perelman School of
Medicine at the University of Pennsylvania, USA
| | - Pradeep Kumar Gupta
- Department of Radiology, Perelman School of
Medicine at the University of Pennsylvania, USA
| | - Kavindra Nath
- Department of Radiology, Perelman School of
Medicine at the University of Pennsylvania, USA
| | - Steven Brem
- Department of Neurosurgery, Perelman School
of Medicine at the University of Pennsylvania, USA
| | - Suyash Mohan
- Department of Radiology, Perelman School of
Medicine at the University of Pennsylvania, USA
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8
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Clinical applications of diffusion-weighted sequence in brain imaging: beyond stroke. Neuroradiology 2021; 64:15-30. [PMID: 34596716 PMCID: PMC8484843 DOI: 10.1007/s00234-021-02819-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/10/2021] [Indexed: 11/20/2022]
Abstract
Diffusion-weighted imaging (DWI) is a well-established MRI sequence for diagnosing early stroke and provides therapeutic implications. However, DWI yields pertinent information in various other brain pathologies and helps establish a specific diagnosis and management of other central nervous system disorders. Some of these conditions can present with acute changes in neurological status and mimic stroke. This review will focus briefly on diffusion imaging techniques, followed by a more comprehensive description of the utility of DWI in common neurological entities beyond stroke.
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9
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Meyers SP. Intracranial Abnormalities with Diffusion Restriction. Magn Reson Imaging Clin N Am 2021; 29:137-161. [PMID: 33902900 DOI: 10.1016/j.mric.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Multiple pathologic conditions can cause changes in the random movement of water, which can be detected with diffusion-weighted imaging (DWI). DWI plays a powerful clinical role in detecting restricted diffusion associated with acute brain infarction. Other disorders can also result in restricted diffusion. This article focuses on showing examples of common and uncommon disorders that have restricted diffusion secondary to cytotoxic and/or intramyelinic edema. These disorders include ischemia, infection, noninfectious demyelinating diseases, genetic mutations affecting metabolism, acquired metabolic disorders, toxic or drug exposures, neoplasms and tumorlike lesions, radiation treatment, trauma, and denervation.
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Affiliation(s)
- Steven P Meyers
- Department of Radiology/Imaging Sciences, University of Rochester Medical Center, University Medical Imaging, 4901 Lac de Ville Boulevard, Building D - Suite 140, Rochester, NY 14618, USA.
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Guedes B, Freua F, Parmera J, Milano B, Comerlatti L, Silva G, Lucato L. Intraventricular Neurocysticercosis: The Role of Advanced MRI Sequences. Neurol India 2020; 68:716-717. [DOI: 10.4103/0028-3886.288999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Barbone F, Peri M, Vitale M, Di Stefano V. Atypical radiological presentation of multiple cystic brain metastases from lung cancer simulating neurocysticercosis. BMJ Case Rep 2019; 12:12/10/e231678. [PMID: 31586960 DOI: 10.1136/bcr-2019-231678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Brain metastases (BMs) are usually characterised by vasogenic oedema and mass effect, but cystic appearance can rarely occur, mimicking parasitosis, such as neurocysticercosis (NCC). A woman in her mid-50s was admitted for dizziness and upper left extremity paresis. Neuroimaging showed multiple cystic lesions consistent with multiple stages of NCC evolution, and empiric albendazole was started, without any clinical improvement. A whole-body CT revealed a pulmonary lesion in the right superior lobe. Pathological analysis from brain specimen demonstrated a clear cell lung carcinoma. The patient gradually worsened and died 4 months after the diagnosis. In conclusion, multiple cystic BMs are an atypical presentation on neuroimaging; in these cases, a meticulous diagnostic workup should be performed, looking for the possible site of malignancy. Even when it is not possible to perform a biopsy from the primitive lesion, as reported in this case, a brain biopsy should be considered.
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Affiliation(s)
- Filomena Barbone
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Marta Peri
- Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Michela Vitale
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Vincenzo Di Stefano
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
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Abstract
PURPOSE OF REVIEW Brain abscesses and spinal epidural abscesses are serious, potentially life-threatening infections of the central nervous system. This article outlines the clinical presentation, evaluation, and management of brain abscesses and spinal epidural abscesses, with a specific focus on bacterial infections. RECENT FINDINGS The overall incidence of brain abscesses has declined, in part because of fewer brain abscesses associated with otogenic infections. However, emerging patient populations at high risk for brain abscess include those with a history of penetrating head trauma, neurosurgery, or immunodeficiency. Improved mortality rates for brain abscess are attributable to modern diagnostic imaging, stereotactic-guided aspiration, and newer antimicrobials that readily penetrate into the central nervous system and abscesses. Brain MRI is more sensitive than CT for brain abscess, particularly in the early stages, but CT remains more widely available and can adequately identify potential abscesses and confirm response to treatment. With the advent of minimally invasive neurosurgical techniques, surgical excision is often employed only for posterior fossa, multiloculated, or superficial well-circumscribed abscesses. In select clinical scenarios, conservative medical management may be a safe alternative to a combined surgical and medical approach. Unlike brain abscess, the incidence of spinal epidural abscess is on the rise and has been attributed to higher prevalence of predisposing factors, including spinal procedures and instrumentation. SUMMARY Successful diagnosis and management of brain abscess and spinal epidural abscess requires a collaborative approach among neurologists, neurosurgeons, radiologists, and infectious disease physicians. The foundation of management of brain abscess includes surgical intervention for diagnostic purposes if a pathogen has not been identified or for decompression of larger abscesses or those with mass effect and significant surrounding edema; appropriate dosing and adequate duration of an antimicrobial regimen tailored to the presumptive source of infection and available culture data, and eradication of the primary source of infection. For spinal epidural abscesses, neurologic status at the time of presentation is directly related to outcomes, underscoring the importance of prompt recognition and intervention.
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Rapalino O, Mullins ME. Intracranial Infectious and Inflammatory Diseases Presenting as Neurosurgical Pathologies. Neurosurgery 2018; 81:10-28. [PMID: 28575459 DOI: 10.1093/neuros/nyx201] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 05/22/2017] [Indexed: 12/28/2022] Open
Abstract
There are many infectious and inflammatory processes affecting the central nervous system that can simulate other neurosurgical pathologies (e.g. tumor) and may precipitate a brain biopsy for definitive diagnosis if not suspected a priori. The challenge for the healthcare team is to recognize imaging features that support a nonsurgical pathology to avoid unnecessary interventions. This review aims to give a general overview of some common inflammatory and infectious entities that affect the central nervous system, with illustrative examples and highlighting important pearls and pitfalls.
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Affiliation(s)
- Otto Rapalino
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Mark E Mullins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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14
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Matamala JM, Fernández-Gajardo R, Yañez A, Cea G, Salinas R. Cerebral ring enhancing lesion with diffusion restriction in a South American patient. Neurol Neurochir Pol 2018; 52:120-122. [DOI: 10.1016/j.pjnns.2017.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/09/2017] [Accepted: 11/09/2017] [Indexed: 11/29/2022]
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15
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Duque KR, Burneo JG. Clinical presentation of neurocysticercosis-related epilepsy. Epilepsy Behav 2017; 76:151-157. [PMID: 28882721 DOI: 10.1016/j.yebeh.2017.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 07/27/2017] [Accepted: 08/02/2017] [Indexed: 11/15/2022]
Abstract
Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system and a major risk factor for seizures and epilepsy. Seizure types in NCC vary largely across studies and seizure semiology is poorly understood. We discuss here the studies regarding seizure types and seizure semiology in NCC, and examine the clinical presentation in patients with NCC and drug-resistant epilepsy. We also provide evidence of the role of MRI and EEG in the diagnosis of NCC-related epilepsy. Focal seizures are reported in 60-90% of patients with NCC-related epilepsy, and around 90% of all seizures registered prospectively are focal not evolving to bilateral tonic-clonic seizures. A great number of cases suggest that seizure semiology is topographically related to NCC lesions. Patients with hippocampal sclerosis and NCC have different clinical and neurophysiological characteristics than those with hippocampal sclerosis alone. Different MRI protocols have allowed to better differentiate NCC from other etiologies. Lesions' stages might account on the chances of finding an interictal epileptiform discharge. Studies pursuing the seizure onset in patients with NCC are lacking and they are specially needed to determine both whether the reported events of individual cases are seizures, and whether they are related to the NCC lesion or lesions. This article is part of a Special Issue entitled "Neurocysticercosis and Epilepsy".
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Affiliation(s)
- Kevin R Duque
- Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru; Hypnos Center for Sleep Medicine, Clínica San Felipe, Lima, Peru.
| | - Jorge G Burneo
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine, Western University, London, Canada.
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Gasparetto EL, Alves-Leon S, Domingues FS, Frossard JT, Lopes SP, Souza JMD. Neurocysticercosis, familial cerebral cavernomas and intracranial calcifications: differential diagnosis for adequate management. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:495-500. [DOI: 10.1590/0004-282x20160054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/22/2015] [Indexed: 11/21/2022]
Abstract
ABSTRACT Neurocysticercosis (NCC) is an endemic disease and important public health problem in some areas of the World and epilepsy is the most common neurological manifestation. Multiple intracranial lesions, commonly calcified, are seen on cranial computed tomography (CT) in the chronic phase of the disease and considered one of the diagnostic criteria of the diagnosis. Magnetic resonance imaging (MRI) is the test that better depicts the different stages of the intracranial cysts but does not show clearly calcified lesions. Cerebral cavernous malformations (CCM), also known as cerebral cavernomas, are frequent vascular malformations of the brain, better demonstrated by MRI and have also epilepsy as the main form of clinical presentation. When occurring in the familial form, cerebral cavernomas typically present with multiple lesions throughout the brain and, very often, with foci of calcifications in the lesions when submitted to the CT imaging. In the countries, and geographic areas, where NCC is established as an endemic health problem and neuroimaging screening is done by CT scan, it will be important to consider the differential diagnosis between the two diseases due to the differences in adequate management.
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Venkat B, Aggarwal N, Makhaik S, Sood R. A comprehensive review of imaging findings in human cysticercosis. Jpn J Radiol 2016; 34:241-57. [DOI: 10.1007/s11604-016-0528-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/04/2016] [Indexed: 11/25/2022]
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Bhat V, Nagarjuna M, Belaval V, Shetty S, Salins PC. Cysticercosis of the masseter: MRI and sonographic correlation. Dentomaxillofac Radiol 2015; 44:20140372. [PMID: 25734242 DOI: 10.1259/dmfr.20140372] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cysticercal involvement of the masseter is an uncommon manifestation of a relatively common parasitic infestation. Sonographic evaluation of many isolated cases of cysticercosis has been extensively described. However, there are scanty reports on MRI appearance of cysticercal involvement of the masseter. This report presents classical imaging appearance of cysticercal involvement of the masseter on sonography and MRI. The pattern of the disease and MRI appearance of lesions in the masseter, highlighting the role of diffusion-weighted images, are described.
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Affiliation(s)
- V Bhat
- Department of Radiology, Narayana Health, Narayana Multispeciality Hospital, Shaw Muzumdar Cancer Center, Bengaluru, Karnataka, India
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Carpio A, Romo ML. The relationship between neurocysticercosis and epilepsy: an endless debate. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:383-90. [DOI: 10.1590/0004-282x20140024] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 02/17/2014] [Indexed: 11/22/2022]
Abstract
Neurocysticercosis (NC), or cerebral infection with Taenia solium, is an important public health problem worldwide. Among the neurological sequelae of NC, seizures have been described as the most common symptom. Acute symptomatic seizures often result from degeneration of a viable cyst; however, not all of these patients with acute or provoked seizures will develop epilepsy (i.e., recurrent unprovoked seizures). Because of the high prevalence of epilepsy and NC, a causal, as well as incidental relationship between the two may exist. The epileptogenicity of calcified cysts as well as the potential association between NC and hippocampal sclerosis necessitates future research. Antihelminthic treatment of NC results in disappearance of viable cysts in about one-third of patients with parenchymal disease, but a reduction in seizure recurrence has not been demonstrated in randomized controlled trials. Prevention is critical to reduce the burden of seizure and epilepsy related to NC.
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Affiliation(s)
- Arturo Carpio
- University of Cuenca, Ecuador; Columbia University, USA
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