[Cerebral hydatid cyst: Clinical case and review of the literature]. / Quiste hidatídico cerebral: caso clínico y revisión de la literatura.

Hydatid disease is an accidental parasitosis, with brain location being rare. The case is reported of a 33year-old male, with no history of note, who was admitted to hospital with intracranial hypertension syndrome and right hemiparesis. Computed tomography showed a cystic lesion in the left frontal-parietal lobule. Surgery was performed by complete excision of the lesion, with a good outcome. Hydatid disease is a rare condition in the brain. Clinical suspicion is important for an early diagnosis. A review is presented on the pathogenesis, diagnosis and treatment of cerebral hydatid disease.

Hydatid disease involving some rare sites in the body.

A hydatid cyst is an endemic disease in our country. Clinical manifestation includes cyst formation, most commonly in the liver and lungs. Renal, brain, and subcuteneous localizations are rare. Here we report four cases: two cases of primary renal hydatid disease, one of intracranial hydatid cyst, and one of subcutaneous hydatid cyst. We discuss the prevalence, diagnostic workup, and management of echinococcosis.

Subcutaneous cysticercosis diagnosed by mitochondrial DNA analysis.

BACKGROUND: Cysticercosis is caused by the larval stage of the pork tapeworm, Taenia solium. Central nervous system, eyes, skeletal muscle, and subcutaneous tissue are the most frequent sites of involvement. METHODS: We report a case of subcutaneous larval cestode where no diagnostic histological features such as scolex or bladder wall can be seen on serial sections. Identification of the pathogen was attempted using mitochondrial DNA analysis of the histopathologic specimen. RESULTS: Analysis of PCR-amplified DNA sequences targeting T. solium mitochondrial cox1 gene and cob gene confirmed the diagnosis. CONCLUSIONS: When characteristic morphology is absent in histopathology specimen, mitochondrial DNA diagnosis is a powerful tool for a definitive diagnosis of cysticercosis. The DNA diagnosis using such histopathologic specimens would also be applicable for identification of other parasites as extensive DNA sequence data are currently available.

Cranial epidural hydatid cysts: clinical report and review of the literature.

BACKGROUND: Cerebral hydatidosis accounts for approximately 1-3% of all cases of hydatid disease. METHOD: In this report, 32-year-old female with epidural multilocular hydatid cysts in the midline posterior parietal region is reported. FINDINGS: Most commonly, cerebral hydatid cysts are single lesions and locate in the watershed of the middle cerebral artery. CONCLUSIONS: However, cerebral epidural hydatid cysts seem to have a tendency occurring around in the highly vascularized venous sinus.

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.

Naming of musical notes: a selective deficit in one musical clef.

We investigated the ability to perform solfeggio, i.e. oral reading of musical notes in MP, a 65 year-old female professional musician, who, following a left temporoparietal ischemia, showed a complex pattern of amusia. The deficit on which we focused was her inability to read orally the bass (F) clef, often substituting it with the violin (G) clef. This problem could not be attributed to a lack of comprehension. The patient could in fact correctly perform on the piano the same sequences she erroneously read aloud; she was also able to correctly judge whether two strings, one in bass clef and the other in violin clef, represented the same sequence of notes. The problem seems to lie in the inability to retrieve note names keeping into account the clef-rule. It is hypothesized that, in the production of note names, this function requires the identification and application of syntactic-like information, in analogy with what is thought to happen in the retrieval of other words.

Regional cerebral blood flow and prognostic evaluation in Alzheimer's disease.

The present investigation reports the application of regional cerebral blood flow (rCBF; (133)Xe method) to prognostic purposes in a consecutive series of 76 patients (mean age 68.4 +/- 8.7 years) with probable Alzheimer's disease (AD; NINCDS-ADRDA criteria). The likelihood that rCBF from a posterior temporal-inferior parietal area in each hemisphere at the first visit may predict timing of achievement of three endpoints (i.e. loss of activity of daily living, ADL, incontinence and death due to end-stage AD) was tested by the 'lifereg' procedure of the Statistical Analysis System package. With respect to baseline evaluation, 32 patients lost ADL 20.6 +/- 17.4 months later, 31 developed incontinence 27.1 +/- 19.0 months later, and 16 patients died after 40.9 +/- 23.8 months of follow-up. Baseline rCBF significantly predicted all end-points: the loss of ADL (left hemisphere: p = 0.04; right hemisphere: p = 0.02), incontinence (p = 0.02 in both hemispheres) and death (p = 0.01 in both hemispheres). Statistical significance was maintained for the loss of ADL and incontinence both in a subgroup of mildly demented patients, in whom death was not considered due to the low number of patients who died, and in a multivariate analysis including patient age, age at onset, sex, duration of illness, Mini-Mental State Examination score and presence of extrapyramidal signs and psychotic symptoms at the first visit. This study shows that rCBF measurement in a posterior temporal-inferior parietal area may give prognostic information on timing of evolution of AD, whenever performed during the course of the disease, and may be utilized both in clinical practice and for social planning.

Parkinsonian symptoms as an initial manifestation in a Japanese patient with acquired immunodeficiency syndrome and Toxoplasma infection.

We studied a Japanese patient who developed parkinsonian symptoms over 3 months before the diagnosis of acquired immunodeficiency syndrome. Brain MRI showed multiple lesions with mass effect and ring enhancement in the basal ganglia and subcortical white matter suggesting Toxoplasma infection. Anti-Toxoplasma therapy and highly active antiretroviral therapy for 6 months allowed improvement of parkinsonism, brain MRI findings, and immune system.

Intracranial hydatid cyst: a report of five cases and review of literature.

The authors present five cases of intracranial hydatid cysts managed at the department of Neurosurgery, King Edward Memorial Hospital, Mumbai, between 1984-1997. The mean age of presentation was 13.4 years. Four patients (80%) were in the first decade of life. All patients presented with focal neurological deficit and clinical features of raised intracranial pressure. Radiological investigations included computerised tomography (CT) scan in three cases, CT and magnetic resonance (MR) scan in one case and accidental cystogram in one case. Two patients had multiple intracranial cysts. One patient had a solitary cyst in the lateral ventricle. Commonest location was in the parietal lobe (3 cases). Total excision of the cyst was done in all five cases. Recurrence was seen in two cases, probably as a result of rupture of the cyst during first surgery. The features of this rare disease are retrospectively analyzed in this presentation and the literature is reviewed.

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.

Chagasic granulomatous encephalitis in immunosuppressed patients. Computed tomography and magnetic resonance imaging findings.

American trypanosomiasis (Chagas' disease), a zoonosis caused by Trypanosoma cruzi with a high incidence in Latin America, may induce an uncommon form of localized encephalitis termed "chagoma", found in few immunocompromised patients. The computed tomography (CT) and magnetic resonance imaging (MRI) findings of brain chagoma are reported for 3 males (ages 32, 32 and 9 yr), the first 2 infected with human immunodeficiency virus (HIV) and the third with acute lymphoblastic leukemia. Diagnosis was confirmed by biopsy. CT disclosed a single, supratentorial, nodular-shaped lesion that substantially enhanced with contrast material, localized in parietal or frontal lobes. T1-weighted MRI showed hypointense lesions that enhanced with gadolinium-diethylenetriaminepentaacetic acid, corresponding to extensive hyperintense areas on T2-weighted images, producing mass effect. The imaging pattern of brain chagoma presented here is similar to that of cerebral toxoplasmosis and should be considered in the differential diagnosis of an intracerebral mass lesion in immunocompromised patients.

Cerebral sparganosis mansoni--case report.

An 80-year-old male with paresis of the right upper extremity underwent surgery for a suspected metastatic brain tumor. A live Sparganum mansoni worm was removed from the parietal lobe through a left parietal craniotomy. Retrospective evaluation of magnetic resonance (MR) images revealed ipsilateral ventricular dilatation, despite the presence of a mass lesion resembling a metastatic brain tumor. This interesting MR imaging finding is an important point for differentiating between a brain tumor and cerebral sparganosis.

Cerebral cysticercosis.

Cerebral cysticercosis is a neurologic disease with myriad manifestations. Three basic types of infections occur: localized, widespread, and proliferative inflammatory reaction. A case is reported illustrating the first type of infection and one type of clinical presentation,--focal seizures. The worldwide distribution of the disease suggests that as global travel increases we will have to consider the diagnosis more often. The diagnosis is established principally through thorough examination of the CSF plus signs of parasitosis in other parts of the body. A history of living in an endemic area should strengthen suspicion. Definitive treatment is currently limited to neurosurgical intervention.