Sanjeeb Kumar Sarma (Down Town Hospital/ Guwahati/ India)  

Für angemeldete Besucher einsehbar (Anmeldung)  

6 Jahre  

Weiblich  

Kopf-Hirn und Hirnnerven  

entzündlich oder infektiös  

6 Jahre altes Maedchen wurde vorgestellt nach drei Krampfanfall-Episoden in den vergangenen 15 Tagen. Ansonsten keine Beeschwerden.  

Noch nicht aus dem Englischen uebersetzt

Neurocysticercosis (NCC) is caused by larval form of pork intestinal tapeworm Taenia Solium. Humans are definitive host. NCC is the most common parasitic infection worldwide. It is endemic in Asia, Africa, Eastern Europe and Latin America. The general autopsy incidence of cysticercosis in those countries is approximately 4%.
CNS infections occur in 60-90% cases of patients with cysticercosis. Brain parenchyma is the most commonly affected site. Corticomedullary junction is the primary location. Intraventricular cysticercosis cysts are seen in 20-50% cases with 4th ventricle a common site. Only 10% cases of NCC have isolated subarachnoid disease.
Morbidity with NCC results from dead larvae that typically incite an intense host inflammatory response. NCC has broad spectrum clinical manifestations. Epilepsy is the most frequent symptom and is seen in 50-70% cases.
Pathologically parenchymal cysticercosis has been classified into four stages: vesicular, vesicular colloidal, granular nodular and nodular calcified. Patients may have multiple lesions at different stages.
Vesicular stage: During this stage cysticercus consists of thin capsule that surrounds a viable larva and its fluid containing bladder. There is no inflammatory reaction seen in this stage. Edema and contrast enhancements are rare in this stage.
Colloidal vesicular stage: In this stage larva dies and degenerate. Cystic fluid becomes turbid and the cyst shrinks as its capsule thickens. Inflammatory response present and edema is seen. Ring like contrast enhancement is seen. MRI scans shows hyperintense cystic fluid compared to CSF at this stage.
Granular nodular: At this stage cyst retracts, its capsules thickens and scolex calcifies which is seen well in CT scan. Perilesional edema is still present and ring enhancement is seen. At this stage the cyst is typically isointense on T1WI and hypointense on T2WI. The present case is in this stage.
Nodular calcified: At this stage size retracts and totally calcified. CT scan shows calcification better than MR.
The patient recovers completely with medication.  

<- MRT 1 betrachten

MRT 1: Axial T1 gewichtete Sequenz zeigt nur schwache Hypointensitaet in der superioren rechts-parietalen Region.





<- MRT 2 betrachten

MRT 2: Axial T2 gewichtete Sequenz zeigt eine 4 mm grosse hypointense Laesion mit umgebenden Oedem in der superioren rechts-parietalen Region.





<- MRT 3 betrachten

MRT 3: Coronal T2 gewichtete Sequenz zeigt die selbe Laesion in der superioren rechts-parietalen Region.





<- MRT 4 betrachten

MRT 4: Axiales FLAIR Sequenz zeigt aehnliches Bild wie in der T2 gewichteten Sequenz.





<- MRT 5 betrachten

MRT 5: Axial T1 gewichtete Sequenz nach Kontrastmittel-Applikation zeigt ein Ring-aehnliche Kontrastaufnahme mit einer zentralen Hypointensitaet.





<- MRT 6 betrachten

MRT 6: Coronale T1 gewichtete Sequenz nach Kontrastmittel-Applikation zeigt die selbe Laesion.





<- MRT 7 betrachten

MRT 7: Sagittal T1 gewichtete Sequenz nach Kontrastmittel-Applikation zeigt die selbe laesion im kortikomedullaeren Uebergang der superioren rechts-parietalen Region.



 

Bildgebung einschl.Endoskopie  

Fehlentwicklung oder posttraumatische Zyste, zystischer Tumor etc.  

Die Prognose ist exzellent. Komplette Heilung kann mit anti-Helminthischen medikamenten erreicht werden.  

Auf einem vorhergehenden CT ohne Kontrastmittel konnte die Laesion nicht gefunden werden. Folge-Bildgebung nach Therapie demonstrierte ein absolut normales MRT.  

Keine Angabe  

1. Medline:
Christopher M. DeGiorgio, Marco T. Medina, Reyna Durón et al
Neurocysticercosis
Epilepsy Curr. 2004 May; 4(3): 107–111.

Diagnostic Neuroradiology by Anne G. Osborn (Mosby)- chapter 16- Infection of the Brain and its linings P- 709-712.  

Neurocysticercose, Taenia solium, Larve, Gehirn, Mensch, Endwirt, Kind, Kindheit, Pädiatrie, Kinderheilkunde  

Sanjeeb Kumar. Neurocysticercose. PedRad [serial online] vol 9, no. 4.
URL: www.Kinderradiologie-online.de/?search=20090428145402