Primary Alveolar Echinococcosis Presenting with Simultaneous Cerebral and Craniofacial Involvement.

Alveolar echinococcosis (AE) is an important parasitic infestation caused by the larval stage of the Echinococcus multilocularis. Turkey is one of the countries occurred endemic of the disease. The disease primarily affects the liver. Cerebral and craniofacial involvements are very rare. Here the authors report a 46-year-old woman with simultaneous cerebral and craniofacial involvement of E. multilocularis. Although primary AE lesions with simultaneous cerebral and craniofacial involvement are exceedingly rare, radiologist must suspect from other unusual involvement such as craniofacial and muscular location in patients with cerebral AE.

Magnetic resonance spectroscopy and magnetic resonance imaging findings of the intracerebral alveolar echinococcosis.

Alveolar echinococcosis (AE) is a parasitic infestation produced by Echinococcus multilocularis. The parasite is a rare human infestation with a wide geographic distribution. It primarily affects the liver, and may spread hematogenously to produce metastatic foci in the distant organs. AE can metastise to the lungs, brain and bones. Cerebral involvement is rare but may be lethal. Cerebral AE is a rare but life-threatening parasitic disease. Here we report a 52-year-old man with cerebellar involvement of Echinococcus multilocularis.

Paucisymptomatic brainstem lesions revealing CNS schistosomiasis.

We describe clinical and magnetic resonance (MR) features in a 69-year-old, Caucasian woman presenting with an unusual meningeal onset of cerebral schistosomiasis. Magnetic resonance work-up demonstrated supra- and infratentorial lesions with prominent brainstem involvement contrasting with the paucisymptomatic clinical presentation. Because of a recent stay in Uganda, including swimming in Lake Victoria, a diagnosis of neuroschistosomiasis was suggested. Serological tests and rectal biopsy confirmed the putative diagnosis. The patient was successfully treated with praziquantel at a dose of 50 mg/kg/day for 15 days. Brain MRI abnormalities improved dramatically within two months.

Inflammatory aneurysm due to neurocysticercosis.

A 69-year old man presented with a subarachnoid hemorrhage associated with a large intracerebral hematoma in the right temporal lobe. The oblique views of cranio-orbital computerized tomographic angiography (CTA) were suspicious for an aneurysm on a middle cerebral artery branch. At surgery, a cystic mass was found in the Sylvian fissure, associated with an aneurysm on a distal branch of the anterior temporal artery. The aneurysm was not situated at a bifurcation of the artery and was located beneath the cyst. It was secured by trapping. Pathological examination revealed that the cystic lesion was neurocysticercosis and that the aneurysm was inflammatory. We report a ruptured inflammatory aneurysm of a distal branch of the anterior temporal artery associated with neurocysticercosis, and present the histological findings. We believe this is the first report of such an inflammatory aneurysm with histological confirmation.

Late onset temporal lobe epilepsy with MRI evidence of mesial temporal sclerosis following acute neurocysticercosis: case report.

UNLABELLED: The objective of this case report is to describe magnetic resonance imaging (MRI) evidence of mesial temporal sclerosis (MTS) in a patient with new onset temporal lobe epilepsy (TLE) and acute neurocysticercosis with multiple cysts. A 56 years old man with new onset headache, Simple Partial Seizures and Complex Partial Seizures underwent CT scan and lumbar puncture as diagnose proceeding. Multiple cysts and meningitis were identified, with a positive immunology for cysticercosis. Seizures were recorded over the left temporal region in a routine EEG. Treatment with albendazole was performed for 21 days, with clinical improvement and seizure remission after 4 months. An MRI scan 11 months after treatment, showed complete resolution of those cystic lesions and a left hippocampal atrophy (HA) with hyperintense T2 signal. The presence of HA and hyperintense T2 signal in this patient has not, to date, been associated with a poor seizure control. CONCLUSIONS: This patient presented with MRI evidence of left MTS after new onset partial seizures of left temporal lobe origin. Although we did not have a previous MRI scan, it is likely that this hippocampal abnormality was due to the acute inflammatory response to cysticercosis associated to repeated partial seizures. This suggests that acute neurocysticercosis associated with repeated seizures may cause MTS and late onset TLE.

Is dementia reversible in patients with neurocysticercosis?

OBJECTIVE: To determine the correlates and outcome of dementia in patients with neurocysticercosis (NCC). METHODS: Ninety consecutive patients with untreated NCC underwent a cognitive assessment (Mini-mental State Examination, Neurobehavioral Cognitive Status Examination, and IQCODE) and were classified as having or not having dementia according to DSM-IV criteria. Imaging and cerebrospinal fluid examination data were recorded. The cognitive measures were repeated six months after treatment with albendazole and steroids. RESULTS: At the initial evaluation 15.5% (n = 14) of the patients were classified as having dementia. Dementia was associated with older age, lower education level, increased number of parasitic lesions in the brain (mostly in the frontal, temporal, and parietal lobes). After six months, 21.5% of the patients from the dementia group continued to have a full dementia disorder and 78.5% no longer fulfilled the DSM-IV criteria for dementia, although some of these patients still showed mild cognitive decline. CONCLUSIONS: The results of this study suggest that dementia occurs frequently in patients with untreated NCC, and it is reversible in most cases.

Acquired epileptic aphasia (the Landau-Kleffner syndrome) due to neurocysticercosis.

A healthy 7-year-old boy developed a language disorder associated with clinical seizures and a paroxysmal EEG. Computed tomography and magnetic resonance imaging revealed a small cysticercus deep in the left Sylvian fissure. We postulate a cause and effect relationship between the parasitic cyst and the clinical manifestations supported by the strategic location of the cyst and the critical age at which this lesion developed. This case provides evidence that the syndrome of acquired epileptic aphasia may be explained in terms of an unilateral structural brain lesion.

Fatal automobile crash caused by cerebral toxoplasmosis.

An unusual case of cerebral toxoplasmosis leading to a fatal vehicular crash is presented. Massive intracerebral hemorrhage, a rare complication of cerebral toxoplasmosis in persons with acquired immunodeficiency syndrome (AIDS), caused sudden onset of increased intracranial pressure that led to loss of control of the vehicle and an ensuing fatal traffic crash.