Neurocysticercosis: A Review

Neuroysticercosis is the most common helminthic infection of the nervous system, and a leading cause of acquired epilepsy worldwide. The disease occurs when humans become intermediate hosts of Taenia solium by ingesting its eggs from contaminated food or, most often, directly from a taenia carrier by the fecal-to-oral route. Cysticerci may be located in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing pathological changes that are responsible for the pleomorphism of neurocysticercosis. Seizures are the most common clinical manifestation, but many patients present with focal deficits, intracranial hypertension, or cognitive decline. Accurate diagnosis of neurocysticercosis is possible after interpretation of clinical data together with findings of neuroimaging studies and results of immunological tests. The introduction of cysticidal drugs have changed the prognosis of most patients with neurocysticercosis. These drugs have shown to reduce the burden of infection in the brain and to improve the clinical course of the disease in most patients. Further efforts should be directed to eradicate the disease through the implementation of control programs against all the interrelated steps in the life cycle of T. solium, including human carriers of the adult tapeworm, infected pigs, and eggs in the environment

Prevalence, correlates, and prognosis of peripheral artery disease in rural ecuador-rationale, protocol, and phase I results of a population-based survey: an atahualpa project-ancillary study

Background. Little is known on the prevalence of peripheral artery disease (PAD) in developing countries. Study design. Population-based study in Atahualpa. In Phase I, the Edinburgh claudication questionnaire (ECQ) was used for detection of suspected symptomatic PAD; persons with a negative ECQ but a pulse pressure ≥65 mmHg were suspected of asymptomatic PAD. In Phase II, the ankle-brachial index will be used to test reliability of screening instruments and to determine PAD prevalence. In Phase III, participants will be followed up to estimate the relevance of PAD as a predictor of vascular outcomes. Results. During Phase I, 665 Atahualpa residents aged ≥40 years were enrolled (mean age: 59.5 ± 12.6 years, 58% women). A poor cardiovascular health status was noticed in 464 (70%) persons of which 27 (4%) had a stroke and 14 (2%) had ischemic heart disease. Forty-four subjects (7%) had suspected symptomatic PAD and 170 (26%) had suspected asymptomatic PAD. Individuals with suspected PAD were older, more often women, and had a worse cardiovascular profile than those with nonsuspected PAD. Conclusions. Prevalence of suspected PAD in this underserved population is high. Subsequent phases of this study will determine whether prompt detection of PAD is useful to reduce the incidence of catastrophic vascular diseases in the region

Movement disorders among adult neurological outpatients evaluated over 20 years in Guayaquil, Ecuador

There is little information available on the evolutive pattern of patients with movement disorders in developing countries. We analyzed 579 consecutive adults with movement disorders and prospectively evaluated them at our institution (Department of Neurological Sciences, Kennedy Clinic, Guayaquil, Ecuador) from 1990 to 2009. Mean age was 62.9±17.5 years, and 50.8% were men. Patients presented with tremor/rigidity (55%), involuntary movements (23.5%) and abnormalities of stance and gait (21.5%). Overall, 45% of our patients had degenerative disorders of the nervous system. We found significant increases in the relative prevalence of tremor/rigidity and abnormalities of stance and gait, and this reflected an increase in the number of patients with degenerative diseases over the study years. We found a dynamic pattern of movement disorders over the years. Today, causes and relative prevalence of these conditions in our population is more similar to that reported from the developed world than it was 20 years ago

Human Neurocysticercosis: An Overview

Human cysticercosis is caused by ingestion of T. solium eggs from taenia carriers. Neurocysticercosis (NCC), defined as the infection of the CNS and the meninges by the larval stage of Taenia solium, is the most common helminthic infection of the CNS worldwide. Parasites may lodge in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing pathological changes that account for the pleomorphism of this disease. Seizures/epilepsy are the most common clinical manifestation, but other patients present with headache, focal deficits, intracranial hypertension, or cognitive decline. Accurate diagnosis of NCC is possible after interpretation of clinical data together with findings of neuroimaging studies and results of immunological tests. However, neuroimaging studies are fundamental for diagnosis because immunological test and clinical manifestations only provide circumstantial evidence of NCC. The introduction of cysticidal drugs changed the prognosis of most NCC patients. These drugs have been shown to reduce the burden of infection and to improve the clinical course of the disease in many patients. Efforts should be directed to eradicate the disease through the implementation of control programs against all the steps in the life cycle of T. solium, including carriers of the adult tapeworm, infected pigs, and eggs in the environment

Isolated brainstem cysticercosis: A review

Review of patients with isolated brainstem cysticercus to outline the features of this form of neurocysticercosis. MEDLINE and manual search of patients with isolated brainstem cysticercus. Abstracted data included: demographic profile, clinical manifestations, neuroimaging findings, evolutive stage of parasites neurocysticercosis, therapy, and follow-up. Twenty-nine patients were reviewed. Of these, 22 (76%) came from India. Mean age was 31 years, and 72% were men. Parasites were located in midbrain (16 patients), pons (12 patients), and medulla (one patient). All but three lesions were less than 10mm in diameter and most were at or near the midline. Most common clinical forms of presentation were isolated paresis of the third cranial nerve, internuclear ophthalmoplegia, and crossed brainstem syndromes. Neuroimaging studies showed colloidal cysticercus in 24 patients, vesicular cysts in four, and a calcification in one. Fourteen patients received cysticidal drugs, eight were treated with steroids alone, and three received no therapy at all. The remaining four patients underwent surgical resection of the lesion. Twenty-seven patients recovered completely and the remaining two were left with mild sequelae. Control neuroimaging studies showed complete or partial resolution of the lesion in the 18 patients in whom they were performed. Isolated brainstem cysticercosis is rare. Clinical and neuroimaging findings on admission allowed a correct differentiation of this condition from other space-occupying lesions of the brainstem (tuberculomas, abscesses, gliomas) in most patients. The prognosis is benign provided the patients receive prompt therapy

Changing pattern of neurocysticercosis in an urban endemic center (Guayaquil, Ecuador)

Objective: To confirm recent evidence suggesting a change in the pattern of disease expression of neurocysticercosis, manifested by a decreasing number of severe and recent infections. Methods: Retrospective cohort of 246 neurocysticercosis patients residing in Guayaquil, evaluated over 20 years (1990 to 2009). Eighty-seven patients were seen from 1990 to 1994, 58 from 1995 to 1999, 57 from 2000 to 2004, and 44 from 2005 to 2009. Neurocysticercosis was classified as active or inactive according to neuroimaging findings. Patients with parenchymal, subarachnoid or ventricular cystic lesions were considered to have active disease, and those with calcifications and chronic arachnoiditis were classified as inactive. Results: Mean age was 36.6 +/- 20 years, and 61% were women. The relative prevalence of active and inactive cases varied according to the year of evaluation. Active neurocysticercosis was found in 63% of patients seen between 1990 and 1994, in 48% between 1995 and 1999, in 47% between 2000 and 2004, and in only 18% between 2005 and 2009 (p<0.0001). Together with reduction of active cases, there was an increased prevalence of asymptomatic infections over the years (from 17.2% between 1990 and 1994 to 54.5% between 2005 and 2009; p<0.0001). Conclusion: In this single-center cohort, the relative prevalence of active cases of neurocysticercosis reduced over the past years, suggesting a decreased incidence of new infections. Improved sanitation together with widespread use of cysticidal drugs were the most likely causes of these findings. (c) 2011 Elsevier B.V. All rights reserved