Hippocampal Atrophy/Sclerosis Is Associated with Old, Calcified Parenchymal Brain Neurocysticercosis, But Not with More Recent, Viable Infections.

Magnetic resonance images from 197 patients with calcified neurocysticercosis (NCC), 38 with viable NCC and 197 NCC-free healthy rural villagers were evaluated to compare the frequency of hippocampal atrophy/sclerosis (HAS) across these populations. Scheltens' medial temporal atrophy scale was used for hippocampal rating. The median age of the 432 study participants was 46 years (interquartile range, 29-62 years), and 58% were women. Hippocampal atrophy/sclerosis was disclosed in 26.9% patients with calcified NCC, compared with 7.9% in patients with viable NCC and 8.1% in healthy rural villagers. After adjusting for age, gender, and history of epilepsy, hippocampal atrophy/sclerosis was more frequent in patients with calcified NCC than in those with viable cysts (RR, 3.60; 95% CI, 1.18- 0.99; P = 0.025) and healthy rural villagers (RR, 3.43; 95% CI, 1.94-6.06; P < 0.001), suggesting that hippocampal damage develops late in the course of this parasitic disease.

A trial of antiparasitic treatment to reduce the rate of seizures due to cerebral cysticercosis.

BACKGROUND: Neurocysticercosis is the main cause of adult-onset seizures in the developing world. Whether therapy with antiparasitic agents results in improved seizure control has been questioned because of the lack of adequate, controlled studies. METHODS: We conducted a double-blind, placebo-controlled trial in which 120 patients who had living cysticerci in the brain and seizures treated with antiepileptic drugs were randomly assigned to receive either 800 mg of albendazole per day and 6 mg of dexamethasone per day for 10 days (60 patients) or two placebos (60 patients). The patients were followed for 30 months or until they had been seizure-free for 6 months after the doses of the antiepileptic drugs had been tapered. The efficacy of treatment was measured as the decrease in the number of seizures after treatment. RESULTS: In the albendazole group, there was a 46 percent reduction in the number of seizures (95 percent confidence interval, -74 to 83 percent) during months 2 to 30 after treatment. This reduction, which was not statistically significant, was composed of a nonsignificant reduction of 41 percent in the number of partial seizures (95 percent confidence interval, -124 to 84 percent) and a significant 67 percent reduction in the number of seizures with generalization (95 percent confidence interval, 20 to 86 percent). Most of the difference in the number of partial seizures was attributable to a few patients who had many seizures during follow-up. The proportions of patients who had partial seizures during follow-up were similar in the two groups (19 of 57 in the albendazole group and 16 of 59 in the placebo group), but the patients in the placebo group had a greater tendency to have seizures with generalization (22 of 59, vs. 13 of 57 in the albendazole group; risk ratio, 1.63; 95 percent confidence interval, 0.91 to 2.92). More of the intracranial cystic lesions resolved in the albendazole group than in the placebo group. With the sole exception of abdominal pain, side effects did not differ significantly between the two groups. CONCLUSIONS: In patients with seizures due to viable parenchymal cysts, antiparasitic therapy decreases the burden of parasites and is safe and effective, at least in reducing the number of seizures with generalization.

Meduloblastomas en niños y adultos. Hallazgos en la Tomografía Axial Computada / Medulloblastoma in children and adults: Findings in Computed Tomography

Objetivo: Describir los hallazgos en la Tomografía Axial Computada (TAC) de pacientes con el diagnóstico de meduloblastoma. Material y Métodos: Se revisaron las TACs de 30 casos (21 niños y 9 adultos) de meduloblastoma comprobados por histopatología. Resultados: en el 60 por ciento de casos el diagnóstico radiológico (DR) fue correcto. Hubo mayor acierto en el DR en niños que en adolescentes y adultos jóvenes. En más del 90 por ciento de casos se halló hidrocefalia, edema peritumoral y compromiso del IV ventrículo. La mayoría de tumores fueron hiperdensos (77 por ciento) y heterogéneos (80 por ciento). Hallazgos poco frecuentes fueron calcificaciones, densidad igual o menor que la sustancia cerebelosa y ausencia de realce con la sustancia de contraste. La imagen típica del meduloblastoma (tumor medial, homogéneo, hiperdenso, hipercaptador de contraste, de márgenes bien definidos) fue observada sólo en el 10 por ciento de casos. Conclusión: la imagen del meduloblastoma es variada; sin embargo, su diagnóstico por TAC es más sensible en pacientes pediátricos que en adultos, debido fundamentalmente a que en niños los hallazgos tomográficos del tumor son más típicos que en adultos.

Procesos expansivos intracraneanos no tumorales: correlato clínico-tomográfico / Non tumor intracranial expansive processes: clinico-topographical correlation

Se presentan 159 casos de procesos expansivos de los cuales se revisan 111 catalogados como no neoplásicos vistos durante los años 1984-1988 en el HGBCH, lhamando la atención fundamentalmente sobre 3 aspectos: (1) la importancia de establecer organicidad en la epilepsia parcial y la epilepsia tardía; (2) la incidencia cada vez mayor de procesos infecciosos e inflamatorios intracraneanos en países en desarrollo; (3) la existencia de dos procesos parasitarios que deben encontrarse en el diagnóstico diferencial de procesos expansivos no tumorales: amebiasis de vida libre, y toxoplasmosis (especialmente en pacientes con SIDA)