Calcified Neurocysticercosis and Headache in an Endemic Village: A Case-Control Study Nested to a Population-Based Cohort.

Headache in patients with calcified neurocysticercosis (NCC) is probably common but has been largely overlooked. We aimed to assess the presence, characteristics, and diagnosis of headache across patients with calcified NCC and their matched controls. In this case-control study nested to a population-based cohort, Atahualpa residents aged ≥ 20 years with calcified NCC were identified as case patients and paired 1:1 to age- and gender-matched randomly selected controls. A culturally adapted questionnaire was derived from the EUROLIGHT. Headache diagnosis was established according to the International Classification of Headache Disorders, 3rd edition. Conditional logistic regression models for matched paired data were fitted to assess the independent association between calcified NCC (as the exposure) and headache variables, after adjusting for education, alcohol intake, depression, and epilepsy. The selection process generated 106 case patients and their matched controls. Lifetime headache prevalence (odds ratio [OR]: 4.18; 95% Confidence Interval [CI]: 1.79-9.75; P = 0.001), current headaches (OR: 4.19; 95% CI: 1.92-9.16; P < 0.001), and intense headaches (OR: 9.47; 95% CI: 2.88-31.19; P < 0.001) were more frequent among cases than in controls. In addition, migraine (but not other forms of headache) was more frequent among subjects with calcified NCC (OR: 4.89; 95% CI: 2.36-11.39; P < 0.001). This study shows a robust epidemiological association between headache-particularly migraine-and calcified NCC.

Muscular cysticercosis: Case report and imaging findings.

Cysticercosis is a parasitic disease caused by a worm of the Cestoda class. The most prevalent form affects the nervous system. This case report is from a 78-year-old female patient evaluated at Clínica Mult Imagem, in the city of Santos, Brazil, who presented a form of the disease that differed from the classic neurocysticercosis, in this case muscular cysticercosis. This and other forms of manifestation justify further studies to ensure adequate recognition, diagnosis and treatment of this parasitic disease.

Muscular cysticercosis: Case report and imaging findings / Cisticercose muscular: relato de caso e aspectos de imagem

Summary Cysticercosis is a parasitic disease caused by a worm of the Cestoda class. The most prevalent form affects the nervous system. This case report is from a 78-year-old female patient evaluated at Clínica Mult Imagem, in the city of Santos, Brazil, who presented a form of the disease that differed from the classic neurocysticercosis, in this case muscular cysticercosis. This and other forms of manifestation justify further studies to ensure adequate recognition, diagnosis and treatment of this parasitic disease.

Resumo A cisticercose é uma parasitose causada pela classe Cestoda. A forma mais prevalente acomete o sistema nervoso. Este relato de caso, obtido da Clínica Mult Imagem, em Santos, é de uma paciente do sexo feminino de 78 anos que apresentou uma forma diversa de neurocisticercose, a muscular. Outras formas de manifestação da doença, como a apresentada neste relato, justificam a realização de mais estudos para assegurar o reconhecimento, o diagnóstico e o tratamento adequados dessa parasitose.

Neurocysticercotic Calcifications and Hippocampal Sclerosis: A Case-Control Study.

OBJECTIVE: The exact role of calcified neurocysticercotic lesions (CNLs) in epilepsy is yet unknown and controversial. Although the relationship between CNLs, epilepsy and mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) has already been addressed, to our knowledge, no study has actually provided strong statistical evidence, nor reported the ODDS ratio for these associations. Therefore, we designed this case-control study to assess the likelihood of having MTLE-HS versus other forms of epilepsy in the presence of CNLs. METHODS: In this case-control study we included 119 consecutive patients with epilepsy and 106 disease controls (headache) with previous CT scans. We subdivided cases into MTLE-HS and other epilepsies. We used brain CT scans to define presence or absence of CNLs. After exploratory analyses, we used logistic regression to analyze the association between CNLs, epilepsy subgroups and disease controls. RESULTS: CNLs were found in 31.09% of cases and in 11.32% of controls (p<0.001). The initial analysis comparing epilepsy versus controls revealed a significant association between CNLs and epilepsy (OR = 5.32; 95%CI = 2.43-11.54; p<0.001). However, when we compared MTLE-HS versus other epilepsies versus controls we confirmed that CNLs were associated with MTLE-HS (OR = 11.27, 95%CI = 4.73-26.85; p<0.001) but other epilepsies were not. We found no difference in the CNLs load and no difference in the location of the CNLs when we compared patients with MTLE-HS, other epilepsies and disease controls. SIGNIFICANCE: The inclusion of controls allowed us to estimate the likelihood of having epilepsy in the presence of CNLs. We found that patients with CNLs were 11 times more likely to have MTLE-HS; however, the presence of CNLs did not change the odds of having other types of epilepsy. These findings raise the possibility of neurocysticercosis playing a role in the pathophysiology of MTLE-HS and need further confirmation in other series.

Lesions associated with Halocercus brasiliensis Lins de Almeida, 1933 in the lungs of dolphins stranded in the Northeast of Brazil.

The parasitic fauna of cetaceans is an important tool for ecological studies, including analyses on the causes of death. Halocercus brasiliensis is a nematode frequently found in the bronchi and bronchioles of some cetaceans, and it is commonly associated with focal inflammation of the respiratory tract leading to bacterial pneumonia and septicemia and, sometimes, to death. The objective of this study was to report infections by H. brasiliensis in the respiratory tract of Delphinidae stranded on the northern seaside of Bahia, Sergipe, and south of Alagoas, all states in the northeast region of Brazil. A total of 30 individuals, 1 Feresa attenuate (pygmy killer whale), 9 Stenella clymene (Clymene dolphin), and 20 Sotalia guianensis (Guiana dolphin) were studied. In 16 of them, the presence of H. brasiliensis was observed with a mean intensity of 3.5 ± 0.6 (range 1-9) in the hosts. Macroscopically, parasitic calcified nodules, lung congestion, edema, and emphysema were observed. Histopathological examination showed interstitial and granulomatous pneumonia with multifocal infiltrates, discrete to moderate edema, congestion, diffuse hemorrhage, and foci of calcification. We conclude that parasitic pneumonia in the sampled individuals may have directly contributed to stranding and death of the animals.

[Brain calcifications: a case presentation of congenital toxoplasmosis]. / Calcificaciones en el cerebro: presentación de un caso de toxoplasmosis congénita.

Toxoplasmosis is a common disease in Latin America. The infection has a major impact on public health worldwide. Congenital toxoplasmosis is part of the spectrum of the disease and the consequences for the newborn are devastating. In this article, we present a case of brain calcifications and hydrocephalus secondary to infection with Toxoplasma gondii in a newborn, as well as the outcome during follow-up and long-term sequelae. It is of high importance for the clinician to think about this disease, due to its high prevalence in Latin America, and to adopt adequate measures for its prevention and timely management in order to reduce long-term sequelae.

La toxoplasmosis es una enfermedad común en la población latinoamericana. Esta infección tiene un gran impacto en la salud pública a nivel mundial. Dentro del espectro de la infección, se encuentra la toxoplasmosis congénita. Las consecuencias de la infección intrauterina por Toxoplasma gondii, son nefastas para el recién nacido. En este artículo se presenta un caso de calcificaciones en el cerebro e hidrocefalia secundarias a infección por Toxoplasma gondii en un recién nacido, así como el desenlace durante el seguimiento y secuelas a largo plazo. Es de importancia que el clínico no olvide la alta prevalencia de toxoplasmosis en la población latinoamericana y que tome medidas adecuadas para su prevención y manejo oportuno que logren disminuir las secuelas a largo plazo.

Quantification of Fas protein in CSF of patients with neurocysticercosis.

UNLABELLED: Neurocysticercosis is a parasitic disease that affects the central nervous system. The objective of this study was to investigate the correlation between neuronal death evaluated by the quantification of Fas apoptotic factor and the different evolutive forms of neurocysticercosis accompanied or not by epileptic seizures. METHODS: Cerebrospinal fluid samples from 36 patients with a diagnosis of neurocysticercosis divided into the following groups: active cystic form (n=15), 9 patients with and 6 without seizures, and calcified form (=21), 9 with and 12 without seizures. Fourteen patients comprised the control group. Fas protein concentrations were determined by ELISA. RESULTS: Only the group of patients with calcified cysts without seizures presented cerebrospinal fluid levels of Fas similar to those of the control group. Higher levels were observed for the other groups. CONCLUSIONS: The present finding suggests high cerebrospinal fluid levels of soluble Fas protein, except for patients with calcified cysts without seizures. Significant differences were observed for the group with calcified cysts and seizures, suggesting greater neuronal damage in these patients. Replacement of the term inactive cyst with reactive inactive cyst is suggested.

Quantification of Fas protein in CSF of patients with neurocysticercosis / Quantificação da proteína Fas no LCR de pacientes com neurocisticercose

Neurocysticercosis is a parasitic disease that affects the central nervous system. The objective of this study was to investigate the correlation between neuronal death evaluated by the quantification of Fas apoptotic factor and the different evolutive forms of neurocysticercosis accompanied or not by epileptic seizures. METHODS: Cerebrospinal fluid samples from 36 patients with a diagnosis of neurocysticercosis divided into the following groups: active cystic form (n=15), 9 patients with and 6 without seizures, and calcified form (=21), 9 with and 12 without seizures. Fourteen patients comprised the control group. Fas protein concentrations were determined by ELISA. RESULTS: Only the group of patients with calcified cysts without seizures presented cerebrospinal fluid levels of Fas similar to those of the control group. Higher levels were observed for the other groups. CONCLUSIONS: The present finding suggests high cerebrospinal fluid levels of soluble Fas protein, except for patients with calcified cysts without seizures. Significant differences were observed for the group with calcified cysts and seizures, suggesting greater neuronal damage in these patients. Replacement of the term inactive cyst with reactive inactive cyst is suggested.

Neurocisticercose é uma doença parasitária que afeta o sistema nervoso central. O objetivo deste estudo foi investigar a correlação entre morte neuronal por meio da quantificação do fator apoptótico Fas e a presença de neurocisticercose nas suas diferentes fases evolutivas, acompanhadas ou não de crises epilépticas. MÉTODOS: Foram analisadas amostras de líquido cefalorraquidiano em 36 pacientes com diagnóstico de neurocisticercose, determinando-se as concentrações da proteína Fas pelo método ELISA. Foram considerados os seguintes grupos: forma cística ativa n=15 (9 com crises, 6 sem crises), forma calcificada n=21 (9 com crises, 12 sem crises) e 14 pacientes (grupo controle). RESULTADOS: Apenas o grupo com calcificações sem crises apresentou níveis de Fas semelhantes ao controle. Maiores níveis foram observados nos outros grupos. CONCLUSÕES: As formas ativa e calcificada apresentam níveis elevados da proteína Fas, exceto para as formas calcificadas sem crises. No grupo de calcificações com crise, observamos diferenças mais expressivas, sugerindo maior dano neuronal. Sugerimos a substituição da denominação "cisto inativo" por "cisto inativo reagente".

Calcified bodies in New World cutaneous leishmaniasis.

We report a case of a 9-year-old boy who presented with 2 lesions that were compatible clinically with cutaneous leishmaniasis of the New World. A skin biopsy showed tuberculoid granulomas with rounded calcified bodies. The diagnosis was supported by a positive leishmanin test and a positive polymerase chain reaction. The patient responded to specific treatment for leishmaniasis. These calcified bodies, described under different names in the literature (Michaelis-Gutmann bodies, Schaumann bodies, psammoma bodies, or conchoidal bodies), have been reported in an experimental leishmaniasis and, only once before, in a case of human leishmaniasis of the Old World.

Surgical treatment for mesial temporal lobe epilepsy in the presence of massive calcified neurocysticercosis.

BACKGROUND: Neurocysticercosis (NCC) is the most common parasitic disease of the human central nervous system and a major health problem for most developing countries. The most common clinical manifestations of NCC are epileptic seizures. Whenever epilepsy and NCC coexist in the same patient, an uncertainty may rise about a causal relationship between them. OBSERVATION: We described a female patient with disseminated calcified NCC lesions and intractable epilepsy. Her medical history included cysticercotic meningoencephalitis and status epilepticus caused by active NCC. Fundoscopy showed the ocular presence of parasite; computed tomography of the brain showed evidence of cystic lesions with the scolex and calcified lesions; enzyme-linked immunosorbent assay of the cerebrospinal fluid was positive for cysticercosis. Epileptic seizures started after an 8-year silent period. Magnetic resonance imaging showed left hippocampal sclerosis. Plain x-ray film showed calcifications in muscles and subcutaneous tissue. Video-electroencephalography and ictal and interictal single-photon emission computed tomography disclosed left mesial temporal lobe epilepsy. The patient underwent left temporal lobectomy and has been seizure free since surgery, for a follow-up of 4 years. CONCLUSION: This case report highlights and supports surgical therapy in patients with epileptic seizures and calcified NCC, even when there are several calcifications, provided that clear localization of epilepsy has been determined by means of a presurgical workup.

[Polycystic hydatidosis: casual finding of calcified hydatid cyst simulating mesenteric neoplasm]. / Hidatidose policística: cisto hidático calcificado, simulando neoplasia mesentérica, descoberto acidentalmente.

A case of abdominal hydatidosis, without hepatic involvement, in a patient from the State of Acre is reported. The hydatid, already in degeneration and partially calcified, was discovered incidentally by a radiologic examination of the vertebral column, carried out for evaluating the state of an intervertebral disk prolapse. Although the images suggested a mesenteric tumor, attached to the intestinal wall, the finding of rostellar hooklets in the dense contents of the cyst, after surgical removal, revealed the parasitic nature of the lesion.

Seizures associated with calcifications and edema in neurocysticercosis.

We describe eight cases of pediatric patients whose neuroimages performed after seizures revealed abnormalities that were compatible with edema surrounding calcified lesions and which disappeared in subsequent examinations.

Calcified cysticerci provoke perilesional edema and seizures.

In cases of cysticercosis, seizures and other symptoms occur in persons with only calcified brain lesions. The presence of perilesional edema has been documented in association with calcified lesions in symptomatic patients, but the frequency of this complication and characteristics of the patients who develop it are not known. Patients in Peru and the United States with neurocysticercosis, documented by positive results of serological testing and with only calcified lesions as shown using computerized tomography, were studied using magnetic resonance imaging. Perilesional edema was observed in slightly more than one-third of the patients, and some patients had frequent, severely disabling episodes. Those with an increased proportion of enhancing calcified lesions were more likely to show perilesional edema. Edema around calcified lesions is common in this population and is associated with seizures and neurological morbidity.