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Neurocysticercosis in Brazilian children: report of 10 cases
M S Ferreira1, J M Costa-Cruz, S A Nishioka
1Centro de Ciências Biomédicas, Universidade Federal de Uberlândia, Brazil.
Insights
Neurocysticercosis in children, a parasitic infection of the brain, often presents with epilepsy or increased intracranial pressure. Early diagnosis and treatment with antiparasitic drugs are crucial for favorable outcomes.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Neurocysticercosis is a significant cause of neurological disorders in endemic areas.
- Pediatric cases present unique diagnostic and management challenges.
Purpose of the Study:
- To describe the clinical characteristics, diagnosis, and treatment of neurocysticercosis in children.
- To emphasize the importance of considering neurocysticercosis in the differential diagnosis of pediatric neurological conditions.
Main Methods:
- Retrospective analysis of ten pediatric neurocysticercosis cases diagnosed over six years.
- Review of clinical presentations, cerebrospinal fluid (CSF) analysis, neuroimaging (radiography, CT), stool examinations, and treatment outcomes.
Main Results:
- Common symptoms included epilepsy and raised intracranial pressure; meningoencephalitis and psychotic reactions were also observed.
- CSF analysis revealed pleocytosis in 6 cases, with lymphocytes and eosinophils predominating. Antibodies to Cysticercus cellulosae were detected in all CSF samples.
- Neuroimaging showed abnormalities in most cases. Stool examination was positive for Taenia sp. in 40% of patients. Treatment with praziquantel or albendazole was effective and well-tolerated, with no surgical intervention required.
Conclusions:
- Neurocysticercosis should be considered in the differential diagnosis of seizures, raised intracranial pressure, meningitis, and psychotic reactions in children from or who have traveled to tropical regions.
- Diagnosis can be suspected with CSF eosinophilia and confirmed by neuroimaging and CSF immunological tests.
- Antiparasitic treatment with praziquantel or albendazole, often combined with dexamethasone, is effective and safe for pediatric neurocysticercosis, avoiding the need for surgery in most cases.
Abstract:
In a 6-year period, ten cases of neurocysticercosis were diagnosed in children with ages ranging from 4 to 13 years, in a Brazilian teaching hospital. Most of the children presented epilepsy and/or raised intracranial pressure, but meningoencephalitis and psychotic reactions were also observed. The cerebrospinal fluid (CSF) cell count ranged from 1 to 52 cells per mm3, with pleocytosis in 6 cases, mostly by lymphocytes and eosinophils. Antibodies to Cysticercus cellulosae were detected in the CSF in all cases. A cranial radiograph was abnormal in 5 out of 6 cases, and a computed tomographic (CT) scan in 4 out of 8 cases. Stool examination was positive for ova and/or proglottids of Taenia sp in 4 out of the 10 cases. Seven patients were treated with either praziquantel or albendazole plus dexamethasone; there were no important side effects, and surgical treatment was required in no case. Neurocysticercosis must be included in the differential diagnosis of seizures, raised intracranial pressure, meningitis and psychotic reactions in children living in or having travelled to the tropics. The diagnosis can be suspected by the presence of eosinophils in the CSF, and confirmed by imaging methods such as CT scans and by immunological tests in the CSF.