RESUMEN
INTRODUCTION: Neurocysticercosis is the commonest cerebral parasitosis. The most recent cases reported in Spain have occurred in patients from endemic countries. The formation of giant subarachnoid cysts (GSC) is an uncommon complication of neurocysticercosis and its treatment is the subject of debate. We report two cases seen recently in the Valle del Jerte, a rural district in Extremadura. CLINICAL CASES: Case 1. A 64 year old man had had complex partial crises (CPC) since 1985. In 1987 he was diagnosed as having neurocysticercosis with parenchymatous cysts and treated with praziquantel. In 1996, on CAT and MR a left frontal GSC was diagnosed and also two parenchymatous active cysts. The cyst was removed surgically and he was subsequently treated with albendazol. Case 2. A 72 year old man had generalized crises and CPC since 1970. In 1987 and 1991 on CAT and MR several parenchymatous lesions compatible with neurocysticercosis were seen. In 1997 he presented with headache and subacute cognitive impairment. On CAT and MR a left temporal GSC was seen with several active parenchymatous lesions. The patient was treated with albendazol and dexamethasone. Both patients improved, although radiological resolution of the GSC in case 2 took a year. CONCLUSIONS: Neurocysticercosis is a condition still present in Spain. GSC respond to treatment with albendazol, whilst surgical treatment is the best option when severe intracranial hypertension occurs.
Asunto(s)
Quistes Aracnoideos/etiología , Encefalopatías/etiología , Neurocisticercosis/complicaciones , Anciano , Quistes Aracnoideos/diagnóstico , Encefalopatías/patología , Áreas de Influencia de Salud , Terapia Combinada , Ensayo de Inmunoadsorción Enzimática , Epilepsias Parciales/diagnóstico , Epilepsias Parciales/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neurocisticercosis/diagnóstico , Neurocisticercosis/terapia , Población Rural , España , Lóbulo Temporal/diagnóstico por imagen , Lóbulo Temporal/patología , Tomografía Computarizada por Rayos XRESUMEN
Introducción. La neurocisticercosis es la parasitosis cerebral más frecuente. Los últimos casos publicados en España han ocurrido en pacientes procedentes de países endémicos. La formación de quistes subaracnoideos gigantes (QSG) es una complicación infrecuente de la neurocisticercosis, cuyo tratamiento es objeto de discusión. Se presentan dos casos observados recientemente en el Valle del Jerte, una comarca rural de Extremadura. Casos clínicos. Caso 1. Varón de 64 años, con crisis parciales complejas (CPC) desde 1984. En 1987 es diagnosticado de neurocisticercosis con quistes parenquimatosos y tratado con praziquantel. En 1996 se diagnostica por TAC y RM un QSG frontal izquierdo y dos quistes activos parenquimatosos. Se practica una extirpación quirúrgica del quiste y, posteriormente, es tratado con albendazol. Caso 2. Varón de 72 años, con crisis generalizadas y CPC desde 1970. En 1987 y 1991 se observan en TAC y RM varias lesiones parenquimatosas compatibles con neurocisticercosis. En 1997 presenta un cuadro de cefalea y deterioro cognitivo subagudo; en TAC y RM se aprecian un QSG temporal izquierdo y varias lesiones parenquimatosas activas. El paciente recibe terapia con albendazol y dexametasona. La evolución es favorable en ambos casos, aunque la resolución radiológica del QSG del caso 2 se demora un año. La serología a cisticerco es positiva en suero en ambos casos y también en el LCR del caso 2. Conclusiones. La neurocisticercosis continúa siendo una entidad presente en España. Los QSG pueden responder al tratamiento con albendazol, mientras que el tratamiento quirúrgico será la mejor opción cuando produzcan hipertensión intracraneal severa (AU)
Introduction. Neurocysticercosis is the commonest cerebral parasitosis. The most recent cases reported in Spain have occurred in patients from endemic countries. The formation of giant subarachnoid cysts (GSC) is an uncommon complication of neurocysticercosis and its treatment is the subject of debate. We report two cases seen recently in the Valle del Jerte, a rural district in Extremadura. Clinical cases. Case 1. A 64 year old man had had complex partial crises (CPC) since 1985. In 1987 he was diagnosed as having neurocysticercosis with parenchymatous cysts and treated with praziquantel. In 1996, on CAT and MR a left frontal GSC was diagnosed and also two parenchymatous active cysts. The cyst was removed surgically and he was subsequently treated with albendazol. Case 2. A 72 year old man had generalized crises and CPC since 1970. In 1987 and 1991 on CAT and MR several parenchymatous lesions compatible with neurocysticercosis were seen. In 1997 he presented with headache and subacute cognitive impairment. On CAT and MR a left temporal GSC was seen with several active parenchymatous lesions. The patient was treated with albendazol and dexamethasone. Both patients improved, although radiological resolution of the GSC in case 2 took a year. Conclusions. Neurocysticercosis is a condition still present in Spain. GSC respond to treatment with albendazol, whilst surgical treatment is the best option when severe intracranial hypertension occurs (AU)