RESUMEN
BACKGROUND: We investigated the proportion of pediatric patients with cerebral paragonimiasis and intracranial hemorrhage who have intracranial pseudoaneurysms. METHODS: Images of 17 pediatric patients with cerebral paragonimiasis that first manifested as secondary intracranial hemorrhage were evaluated. All patients underwent computed tomographic angiography before surgery. A diagnosis of cerebral paragonimiasis was confirmed based on a positive Paragonimus-specific antibody test in serum samples from all 17 patients. Cerebral paragonimiasis in five of the 17 patients was further confirmed by histopathological examination of surgical specimens. RESULTS: Computed tomographic angiographic images for six of the 17 patients (35.3%) showed the presence of intracranial pseudoaneurysms. Follow-up computed tomographic angiographic scans two years later showed that two of the six patients had persistent pseudoaneurysms and underwent aneurysmectomy. The diagnosis of pseudoaneurysm was confirmed by histopathological examination postsurgery. In another two of the six patients, the pseudoaneurysm lesions were absorbed and could no longer be seen on three- to six-month follow-up scans. The final two patients with pseudoaneurysms are still under follow-up. Intracranial pseudoaneurysms with various degrees of surrounding hemorrhage were frequently observed at first manifestation. CONCLUSIONS: The rupture of intracranial pseudoaneurysms is a common characteristic feature of secondary intracranial hemorrhage caused by cerebral paragonimiasis in pediatric patients.
Asunto(s)
Aneurisma Falso/diagnóstico , Helmintiasis del Sistema Nervioso Central/diagnóstico , Hemorragias Intracraneales/diagnóstico , Paragonimiasis/diagnóstico , Adolescente , Aneurisma Falso/etiología , Aneurisma Falso/cirugía , Helmintiasis del Sistema Nervioso Central/sangre , Helmintiasis del Sistema Nervioso Central/complicaciones , Angiografía Cerebral , Niño , Preescolar , Angiografía por Tomografía Computarizada , Femenino , Estudios de Seguimiento , Humanos , Hemorragias Intracraneales/etiología , Masculino , Paragonimiasis/sangre , Paragonimiasis/complicacionesRESUMEN
To evaluate possible blood-brain barrier (BBB) dysfunction caused by matrix metalloproteinase-9 (MMP-9) and its regulation by tissue inhibitors of metalloproteinase (TIMPs) in patients with eosinophilic meningitis caused by infection with Angiostrongylus cantonensis, 40 patients and 28 controls were included in this study. Concentrations of MMP-2, MMP-9, TIMP-1, and cerebrospinal fluid (CSF):serum albumin ratios (Q(Alb) values) were significantly increased in patients compared with controls. However, concentrations of TIMP-4 were significantly lower in patients. In contrast to MMP-2, proteolytic activity of MMP-9 detected by gelatin zymography was only observed in patients with eosinophilic meningitis. We detected higher levels of antibodies specific for A. cantonensis and higher Q(Alb) values and MMP-9 concentrations in CSF of patients with eosinophilic meningitis, Furthermore, the increase in the Q(Alb) value was significantly correlated with the increase in MMP-9 in patients. In parallel with CSF MMP-9, patients also showed an increase in CSF leukocyte counts. Gradual decreases in levels of Q(Alb), MMP-9, and TIMP-1 and increases in levels of TIMP-4 were observed in six patients during recovery from eosinophilic meningitis. These results suggest that the source of MMP-9 in CSF of patients with eosinophilic meningitis was probably associated with leukocytes migrating from peripheral blood to CSF. Activity of MMP-9 in CSF of patients could not be completely inhibited because of the decrease of TIMP-4, which may cause BBB dysfunction, as shown by higher Q(Alb) values in patients.
Asunto(s)
Angiostrongylus cantonensis , Helmintiasis del Sistema Nervioso Central/líquido cefalorraquídeo , Metaloproteinasa 9 de la Matriz/líquido cefalorraquídeo , Infecciones por Strongylida/líquido cefalorraquídeo , Inhibidores Tisulares de Metaloproteinasas/líquido cefalorraquídeo , Animales , Anticuerpos/sangre , Barrera Hematoencefálica/fisiopatología , Estudios de Casos y Controles , Helmintiasis del Sistema Nervioso Central/sangre , Helmintiasis del Sistema Nervioso Central/fisiopatología , Ensayo de Inmunoadsorción Enzimática , Eosinofilia/líquido cefalorraquídeo , Eosinofilia/parasitología , Eosinofilia/patología , Humanos , Albúmina Sérica , Infecciones por Strongylida/sangre , Infecciones por Strongylida/fisiopatología , Inhibidor Tisular de Metaloproteinasa-4RESUMEN
The aim of this study is to evaluate the contribution of the immunoWesternblot for the diagnosis and the post surgical follow-up of the hydatidosis. 71 sera from patients with hydatidosis confirmed by surgery were studied. All had a negative hydatic serology by screening tests (enzyme-linked immunosorbent assay, hemagglutination, electrosyneresis). 12 patients with sera in pre and post operative were monitored for 2 years. The Echinococcus Western blot IgG permitted to rectify the diagnosis of hydatidosis in 67.6 %. The rate of positivity was 100 % for the multivesicular liver cysts, 60 % for the young cysts and 50 % for the calcified cysts. Western blot permitted to rectify the diagnosis of lung cysts in 62.5 % of cases and in 50 % of cranial-spinal localizations. Analysis of Western Blot evolution in the 12 patients followed in pre and post-surgical revealed the disappearance of the bands 16, 18 and 26-28kDa in 8 month in the 8 patients with complete exeresis. This study proved the value added of Western blot compared to the other traditional techniques for the immunodiagnostic and the post-surgical monitoring of hydatidosis.