[Neurocysticercosis. I. Clinical and laboratory course of 151 cases]

Neurocysticercosis is a serious public health problem in our midst, which accounted for 7.3% of the hospital admissions and 2.7% of all cases of the out patient clinic attendance of the Discipline of Neurology of the School of Medicine--Ribeirão Preto, São Paulo University, from 1979 to 1986. A total of 151 patients with a minimum follow-up of 6 months were selected for the present study including clinical and laboratory evolution, a topic which is rarely considered in the literature. The onset of the disease was characterized by: epileptic seizures in 82 patients (54.3%), increased intracranial pressure (ICP) in 40 (26.5%), meningitis in 21 (13.9%), headache in the absence of increased ICP or meningitic signs in 7 (4.6%), and spinal cord syndrome in 1 (0.6%). In the group with the epileptic form, 36.6% of the patients later developed other neurological syndromes, such as cysticercotic meningitis, mental disorders and increased ICP after a 6 to 7 years interval. In the group with the hypertensive form, 55% of the patients developed other manifestations during the period of evolution, especially meningitis and epileptic seizures, after a significantly shorter interval than for the epileptic form. In the meningitic form, 19% of the patients showed a recurrence of the syndrome after a mean interval of 10.7 weeks: an additional 66.6% developed a combination with other syndromes, especially increased ICP and epileptic seizures. The death rate was 7.9%, the main cause being increased ICP (83.3%). When the abnormalities of the complementary tests were investigated in the various forms of clinical presentation in terms of their predictive value it was concluded that, in the epileptic form, the presence of cysts in CT scan and/or abnormalities in CSF indicates a greater risk of developing other neurologic syndromes. No significant differences in the patterns of abnormalities of these investigations were detected in the remaining clinical forms. Most cystic lesions detected by CT scan (90.9%) were associated with CSF abnormalities, especially pleocytosis and positive complement fixation test. Conversely, this proportion was only 26% in patients with calcifications.