Neurocysticercosis presenting as focal hydrocephalus.

A 40-year-old man presented with a 2-month history of headache, nausea and vomiting, with generalised seizures for the past 15 days. On examination he had bilateral papilloedema, visual acuity was 6/6 in both eyes but perimetry showed right homonymous inferior quadrantanopia. His MRI showed numerous small cystic lesions with eccentric nodules, diffusely distributed in bilateral cerebral and cerebellar hemispheres. There was also focal hydrocephalus involving occipital and temporal horns of the left lateral ventricle leading to its selective dilation. Stool examination showed ova of Taenia solium. He was treated with albendazole, prednisone and sustained release sodium valproate for 1 month. His headache resolved and he is free of seizures. Repeat perimetry at 1 month also showed resolution of visual field defect.

Coenurus cerebralis cysts in the left lateral cerebral ventricle of a ewe.

A three-and-a-half year-old female Rahmani ewe was presented suffering from nervous symptoms. Grossly, a large cyst measuring 7 × 4 cm and weighing 145 g occupied the dilated left lateral ventricle. The overlying cerebral tissue was thin, atrophied and congested. It tore easily, and the cyst was evacuated spontaneously. Microscopically, liquefactive necrosis surrounded by aggregations of macrophages, eosinophils, lymphocytes, fibroblasts and giant cells was predominantly observed. Hyperplasia and severe necrosis of the ependymal cell lining of the lateral ventricle were observed. Extensive subependymal inflammatory cell infiltrations, accompanied by neovascularization and fibroblastic proliferation, were seen. Based on the gross and histopathological lesions and cyst morphology and location, the cyst was diagnosed as Coenurus cerebralis. This report describes a rare case of coenurus cyst in the left lateral cerebral ventricle of a ewe and the associated lesion.

Strongyloides stercoralis hyperinfection: difficulties in diagnosis and treatment.

Immunocompromised patients who are infected with Strongyloides stercoralis may develop a potentially fatal auto-infection syndrome characterised by non-specific pulmonary and gastrointestinal symptoms and Gram negative sepsis. We present the case of one such patient who underwent a negative laparotomy for a presumed intra-abdominal surgical catastrophe with a subsequent protracted stay on the intensive care unit. Once the diagnosis of strongyloidiasis was made, the patient was successfully treated with subcutaneous antihelminthic drugs. With appropriate screening for and eradication of strongyloides in those with immune compromise, or in those about to start immunosuppressive therapy, potentially fatal episodes of hyperinfection could be avoided. In the absence of screening, severe strongyloidiasis should be suspected in immunosuppressed individuals who have travelled to or resided in an endemic area and present with the characteristic features. Awareness of the signs of hyperinfection amongst those involved in acute care could prevent unnecessary morbidity and mortality in these patients.

Intracranial hydatidosis. Report of a case diagnosed on cerebrospinal fluid cytology.

BACKGROUND: Hydatidosis occurs due to infestation with the larval stage of the Echinococcus species. Humans are incidental hosts. Symptoms and signs in humans are a slowly growing mass lesion, especially in the central nervous system. Diagnosis depends on the appropriate presentation and history with corroborative radiology and serology. Microscopic detection of characteristic parasitic scolices and hooklets is confirmatory. CASE: A 10-year-old girl presented with complaints of headaches and convulsions for the preceding several months. Computed tomography findings showed asymmetric dilatation of the right lateral ventricle by an intraventricular, focally calcified mass. The radiologic suspicion was an intraventricular tuberculoma, hydatid cyst or choroid plexus papilloma. Cytologic examination of cerebrospinal fluid (CSF) smears revealed characteristic echinococcal components. CONCLUSION: Intracranial hydatid cyst is a fairly uncommon manifestation of an echinococcal infestation and shares clinicoradiologic features with several intracranial, space-occupying lesions. Cytologic examination of CSF samples may be employed to detect confirmatory evidence of a clinical/radiologic suspicion.

Endoscopic management of cysticercal cysts within the lateral and third ventricles.

OBJECT: In this report the authors review their 3-year experience with the endoscopic management of patients with hydrocephalus who harbored cysticercal cysts within the third and lateral ventricles. The management plan was to utilize an endoscopic approach to remove the cysts and to incorporate techniques useful in treating obstructive hydrocephalus. The ultimate goals were to avoid having to place a complication-prone cerebrospinal fluid shunt and to eliminate the risk of complications related to cyst degeneration. METHODS: A retrospective analysis of 10 patients with hydrocephalus and cysticercal cysts within the third or lateral ventricles who were endoscopically managed was performed. A general description of the instrumentation and technique used for removal of the intraventricular cysts is given. At presentation, neuroimaging revealed findings suggestive of obstructive hydrocephalus in eight patients. Seven of the 10 patients treated endoscopically were spared the necessity of shunt placement. Three successful third ventriculostomies and one therapeutic septum pellucidotomy were performed. Despite frequent rupture of the cyst walls during removal of the cysts, there were no cases of ventriculitis. The endoscopic approach allowed successful removal of a cyst situated in the roof of the anterior third ventricle. One patient suffered from recurrent shunt obstructions secondary to a shunt-induced migration of cysts from the posterior fossa to the lateral ventricles. CONCLUSIONS: The endoscopic removal of third and lateral ventricle cysticercal cysts, combined with a third ventriculostomy or septum pellucidotomy in selected cases, is an effective treatment in patients with hydrocephalus and should be considered the primary treatment for this condition.