Cysticercosis of the Brain

What is Cysticercosis of the Brain?

Cysticercosis of the brain is a parasitic disease of the nervous system that occurs when a porcine tapeworm egg (Tanenia solium) enters the human gastrointestinal tract.

Cysticercosis of the brain (neurocysticercosis) is caused by the penetration of larvae of the porcine tapeworm (Taenia solium) into the brain, where they transform into encapsulated Finns (or otherwise, cysticerci) and can last for many years. Neurocysticercosis has important social significance, as it is one of the most common causes of acquired epilepsy in the world.

It occurs in 2-4% of the general population, more often in adults, equally often in men and women.

Pathogenesis during Brain Cysticercosis

In the biological cycle of the development of pork tapeworm, man is the ultimate host. The adult form of tapeworm lives in the human intestines. For the development of cysticercosis, it is necessary for the helminth eggs to enter the stomach and intestines, where, under the influence of gastric juice, the dense shell of the eggs dissolves and the released embryos spread through the blood vessels to human tissues and organs. Most often (more than 60%), the cysticercus enters the brain, less commonly the skeletal muscles and eyes. The life span of the parasite in the brain is from 5 to 30 years.

Cysticercosis is a bubble filled with a clear fluid, ranging in size from a pea to a walnut (from 3 to 15 mm in diameter). On the inner surface of the bubble is the head of the Finns – scolex with hooks and suction cups. In most cases, there are hundreds and thousands of parasites in the brain, but isolated cysticerci are also found. They are localized in the pia mater on the base of the brain, in the surface of the cortex, in the cavity of the ventricles, where they can freely swim. Dying, the parasite calcifies, however, remaining in the brain, supports the chronic inflammatory process.

Cysticercosis has a toxic effect on the nervous system and causes reactive inflammation of the surrounding brain tissue and membranes. Cysticercosis is accompanied by cerebral edema, hydrocephalus due to increased secretion of cerebrospinal fluid by the choroid plexuses, mechanical obstruction of cerebrospinal fluid circulation, and reactive leptomeningitis.

Symptoms of Cysticercosis of the Brain

Due to the small size of the blisters and their low density in the clinical picture of cysticercosis, mainly irritation symptoms are observed. Signs of loss of neuron function for a long time are absent or very weakly expressed. Patients may have shallow paresis, minor sensitivity disorders, mild speech impairment. Symptoms of irritation are manifested by attacks of local Jacksonian and general convulsive epileptic seizures. Frequent long light intervals between seizures, as well as status epilepticus. The polymorphism of Jackson’s seizures is characteristic, which indicates the multiplicity of foci in the cerebral cortex.

Various changes in the psyche are typical for cysticercosis. They are expressed by neurotic manifestations, and in more severe cases – in excitement, depression, hallucinatory-delusional phenomena, Korsakov’s syndrome.

Liquor hypertension and cerebral edema are manifested by paroxysmal intense headache, vomiting, dizziness, congestive optic nerves.

With localization of the cysticercus in the ventricle, Bruns syndrome occurs, which consists in a paroxysmal sharp headache, vomiting, forced head position, respiratory distress and cardiac activity, sometimes impaired consciousness. The syndrome is based on irritation by the cysticercus of the bottom of the IV ventricle. In other cases, Bruns syndrome develops as a result of acute cerebrospinal fluid hypertension with occlusion of the IV ventricle cysticercus.

Cysticercosis of the lateral ventricles proceeds as a tumor of the frontal or callous localization with periodic impairment of consciousness when the Monroe opening is blocked.

Cysticercosis of the base of the brain (usually racemose in the form of a bunch of grapes) gives a picture of basal meningitis, which occurs with headache, vomiting, bradycardia, damage to the optic nerves and paralysis of cranial nerves VI and VII.

Flow. Prolonged, remitting, with sharply expressed periods of deterioration and light gaps for several months and even years. Spontaneous cure is not observed.

Diagnosis of Cysticercosis of the Brain

In the study of cerebrospinal fluid, lymphocytic and eosinophilic cytosis is detected, sometimes an increase in the increase in protein level (from 0.5 to 2 g / l), in some cases, scolex and scraps of the cysticercus capsule. Lumbar puncture should be done carefully, since with cysticercosis of the IV ventricle, taking cerebrospinal fluid can cause sudden death of the patient.

Eosinophilia is often noted in the blood. RSC blood and especially cerebrospinal fluid using cysticercic antigen have diagnostic value. The Lange reaction is paralytic.

On the craniogram, scattered small formations with dense contours are sometimes found – calcified cysticerci, which can also be found in the muscles of the limbs, neck, and chest. Sometimes the cysticercus is found on the fundus. As a manifestation of cerebrospinal fluid hypertension in the fundus, congestive disks of the optic nerves are noted.

It is extremely difficult to diagnose brain cysticercosis due to the absence of pathognomonic symptoms. The diagnosis is based on the following features of the disease: a multiplicity of symptoms, indicating multifocal brain damage, the prevalence of irritation, signs of increased intracranial pressure, a change in the patient’s serious condition with periods of well-being. Radiography, CT, MRI, as well as eosinophilia of blood and cerebrospinal fluid, positive CSC with a cysticercic antigen help diagnose.

Cysticercosis should be differentiated from a brain tumor, neurosyphilis, meningoencephalitis, epilepsy, etc.

Brain Cysticercosis Treatment

Brain cysticercosis is treated with praziquantel (50 mg / kg / day for 2 weeks) or albendazole (15 mg / kg / day for 1 month). Against the background of taking these drugs, an increase in epileptic seizures, an increase in headache and other symptoms of intoxication with the decay products of perishing cysticerci cysts are possible. To reduce such phenomena, dexamethasone or non-hormonal anti-inflammatory drugs, as well as dehydrating and anticonvulsants are used.

With the cysticercus of the IV ventricle and single cysts localized in accessible areas of the cerebral cortex, surgical intervention with their removal is indicated. Such an operation often leads to recovery.

Forecast. With multiple cysticercosis and cysticercosis of the IV ventricle, the prognosis is always serious. Death can occur during epileptic status or with the development of acute occlusal hydrocephalus. With regard to disability, the prognosis is also unfavorable due to increased intracranial pressure, which is accompanied by persistent headaches, frequent epileptic seizures, and changes in the psyche.

Prevention of Brain Cysticercosis

Of great importance is the observance of personal hygiene rules, the appropriate processing of food products, vegetables, fruits, sanitary supervision in slaughterhouses for pork carcasses.