LYCOS RETRIEVER 
Cysticercosis: Patients
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In this country, cerebral cysticercosis is not commonly implicated as the etiology of an otherwise uncomplicated seizure disorder occurring during childhood. Nine children with neurologic symptomatology and radiographic (computed tomography) evidence consistent with cerebral cysticercosis have been evaluated. Each patient was born and resided for some period (1 to 10 years) in an endemic area. Principal symptomatology consisted of a generalized seizure disorder. EEGs were normal in five patients and nonspecific in two. Serologic studies on serum and CSF were negative in 8/9 patients including the single patient requiring surgical intervention for excision of a cysticercal cyst.
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A second neurosurgical consultant suggested the possibility of cysticercosis, and infectious disease consultation was obtained. The patient had blood titers drawn to test for cysticercosis by Western blot. The initial test was negative, but a repeat study 3 weeks later was positive. Cysticercus antibodies IgG, IgM and IgA were all negative. The patient was placed on an empiric trial of praziquantel and prednisone. Three weeks later, MR showed a definitive shrinkage of the cystic lesion with thickening of the capsule.
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Four hundred ninety-seven patients were identified as having been treated for cysticercosis at four hospitals in Los Angeles during the 11-year period 1973 through 1983. Eleven deaths were recorded. Over 90% of these patients were Hispanics in productive age groups; the majority were Mexican by nationality. Hospitalizations were generally short, and readmissions for recurrence of symptoms or complications of therapy occurred in only 14% of patients. Cysticercosis was diagnosed in 12 US citizens who had no history of travel to countries considered traditionally endemic for Taenia solium taeniasis/cysticercosis. A dramatic rise in numbers of cases was observed after 1977, appearing to plateau at approximately 80 cases per year in 1981.
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The management of cysticercosis can involve chemotherapy, surgery, and supportive medical treatment. Intestinal T. solium infection is treated with praziquantel. Asymptomatic patients with calcified soft tissue or neural lesions generally require no treatment. For symptomatic patients with neurocysticercosis, both praziquantel (50 mg/kg per day in three doses for 15 days) and albendazole (15 mg/kg per day in three doses for 8 to 28 days) are effective. Because both agents provoke inflammatory responses around dying cysticerci, patients receiving either drug should be hospitalized and given high doses of glucocorticoids during treatment. For ocular and spinal lesions, drug-induced inflammation may cause irreversible damage; ... these lesions as well as those within the ventricles are best managed by surgical resection.
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Cysticercosis in the eyelid is usually seen as a painless enlarging mass.[10] Subconjunctival lesions tend to present as hyperemic epibulbar masses that are sometimes fluctuant. Cysticerci may ... be seen in the anterior chamber attached to the iris or on occasion to the anterior lens capsule. Cysticerci of the posterior segment are usually seen in the vitreous body[11] or in the subretinal space.[12],[13] The parasite is brought via the posterior ciliary arteries to the subretinal space usually in the region of the posterior pole. The subretinal cysts may vary in size from 3-6 disc diameters and have a single central scolex. Contraction and undulation of the cyst was seen periodically in two cases (Cases 6 & 7), which were accentuated by light. One patient (Case 7) had a full thickness macular hole; presumably this may be the entry site of the cyst into the vitreous cavity presenting as a translucent free floating cyst.
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Five hundred patients with cysticercosis of the nervous system were evaluated by scanning that used anti-Cysticercus antibodies labeled with indium 113. The same antibodies, labeled with iodine 131, were used for radioimmunotreatment. Ninety-six percent of the patients had good or excellent results, whereas only 4% had poor results. None of the patients showed intolerance or radiotoxicity during three months of clinical and laboratory follow-up. The diagnosis, treatment, and prognosis of cysticercosis of the nervous system are dramatically changing, due to the development of anti-Cysticercus antibodies labeled with radionuclides.
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