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[Cerebrovascular disease and neurocysticercosis]
M S Rocha1, S M Brucki, A C Ferraz
1Serviço de Neurologia Clínica, Hospital Santa Marcelina, São Paulo, SP, Brasil. msrocha@uol.com.br
Abstract:
We report three cases of stroke secondary to neurocysticercosis. The first one is a 36 years old man with bilateral middle cerebral artery occlusions who had presented acute right hemiparesia and aphasia. MRI demonstrated several enhancing subarachnoid cysts surrounding the occluded vessels, a right parietal racemose cyst and a left temporal large infarction area. Angiographic study showed total occlusion of left middle cerebral artery and a subtotal occlusion of right middle cerebral artery. The second one is a 42 years old man with vasculitis of small cortical vessels who presented with headache, seizures and focal neurological deficit. CT scan demonstrated several calcifications and a left temporal infarction area. Cerebral angiographic study was normal. The third case was a woman, 53 years old, with a past history of six stroke events and an actual behavior disturbance and seizures. MRI demonstrated several cortical and subcortical infarction areas and cisternal cysts. Angiographic study showed diffuse arteritis of basilar and carotid arterial system. In all three cases CSF study showed linfomonocitic pleocytosis and positive ELISA for cysticercosis.
Insights
Neurocysticercosis can cause stroke by affecting cerebral arteries and vessels. This parasitic infection leads to various neurological deficits, including hemiparesis, aphasia, seizures, and focal neurological deficits.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Neurocysticercosis is a significant cause of acquired epilepsy and neurological disease globally.
- Cerebrovascular complications, including stroke, are increasingly recognized manifestations of neurocysticercosis.
Observation:
- Three distinct cases of stroke secondary to neurocysticercosis are presented.
- Case 1: A 36-year-old male with middle cerebral artery occlusions, subarachnoid and racemose cysts, and infarction.
- Case 2: A 42-year-old male with small vessel vasculitis, calcifications, and infarction.
- Case 3: A 53-year-old female with recurrent strokes, infarction, cisternal cysts, and diffuse arteritis.
Findings:
- Cerebral imaging revealed cysts, infarcts, occlusions, and arteritis in affected individuals.
- Cerebrospinal fluid (CSF) analysis showed lymphomonocytic pleocytosis and positive ELISA for cysticercosis in all cases.
Implications:
- Highlights the importance of considering neurocysticercosis in the differential diagnosis of stroke, especially in endemic areas.
- Emphasizes the diverse cerebrovascular manifestations of neurocysticercosis, necessitating thorough diagnostic workup.
- Underscores the role of advanced neuroimaging and serological tests in diagnosing neurocysticercosis-related stroke.