Neurocysticercosis: clinical, epidemiological and diagnostic aspects. A prospective study of 157 patients in the northeastern region Bahia State, Brazil

THESES

NEUROCYSTICERCOSIS: CLINICAL, EPIDEMIOLOGICAL AND DIAGNOSTIC ASPECTS. A PROSPECTIVE STUDY OF 157 PATIENTS IN THE NORTHEASTERN REGION ­ BAHIA STATE, BRAZIL (Abstract)^*. THESIS. NITEROI, 1997.

ANTONIO DE SOUZA ANDRADE FILHO^**

Neurocysticercosis (NC) is a parasitic disease, common in our environment, displaying different neurological manifestations. It has been known since ancient times, and described around 380 to 375 b.C. in one of Aristophanes' comedies. It has been reported for the first time in Brazil by Magalhães, in Bahia State, in 1881. It is a typical parasitosis in developing areas, significantly associated to poor hygiene and basic sanitation conditions, mainly in areas where extensive swine breeding has taken place. The disease is endemic in Mexico, Central and South America, Indonesia and East Europe, being often found in Portugal, Spain and Poland, but also reported in other countries.

The life cycle of the parasite presents important characteristics, with phases at which it is found in different stages. It is important to understand its morphological structures and the contribution of these stages to perpetuate infestation. Man, inside life cycle, can take part as a definitive host, being bearer of the adult worm form (Taenia solium ­ teniasis), or as an intermediary host, displaying the larva form (Cysticercus cellulosae ­ cysticercosis) inside tissues, mainly in the central nervous system (75%), which has been the subject of the present study; it can also reach the retina, the heart, the (striated) muscles, and the subcutaneous tissue, among others.

In NC, the cysts can be located at the parenchyma (gray matter or periventricular tissue), at the ventricular system or at the subarachnoid space, bringing up several clinical pictures. The NC diagnosis is based mainly on the patient's epidemiological history, clinical symptoms, cerebrospinal fluid (CSF) study and neuroimage exams.

The purpose of this study is, besides reviewing world literature about NC, to carry out a prospective analysis of 157 patients followed up during a minimal period of six months, from March 1988 to December 1995: at the Neurology Service of University Hospital Professor Edgard Santos, attached to the Medicine Faculty of Bahia Federal University; at the Santa Isabel Hospital, attached to Bahia School of Medicine and Public Health; and at the Neurology and Neurosurgery Foundation, Brain Institute.

The average age was 29.2 ± 13.1, with a proportion of 58.6% males and 41.4% females. Several other demographic features ­ such as color, schooling, occupation and origin, among others ­ were studied as to determine these patient's epidemiological aspects. The disease has clinically appeared as pure convulsion in 80.3% of cases, intracranial hypertension syndrome (ICHS) in 9.6%, psychic form in 5.1%, convulsive form plus ICHS in 3.8%, and as convulsive form plus psychic form in 1.3% of cases. In this series, none of the 157 patients displayed spinal cord damage. The physical exam was normal in majority of patients (83.4%); 8.3% of cases had hemiparesis, 2.5% had hemiplegia; in some cases occurred dysarthria, cerebellar syndrome, alterations of cranial nerves, and associated forms. It was performed the analysis of the evolution of image, CSF and electroencephalographic exams in three distinct periods: starting or diagnostic period, post-intervention period (30 days after treatment), and control period (six months after treatment).

With this study, bearing a pioneer character in Bahia State ­ Northeastern Region, it was possible to emphasize the clinical, epidemiological and diagnostic aspects which are relevant to characterize NC, and are useful for better understanding this affection in our environment.

KEY WORDS: cysticercosis, central nervous system, clinical aspects, diagnosis, epidemiology, bioestatistics.

** Address: Departamento de Neuro-Psiquiatria, Faculdade de Medicina, Universidade Federal da Bahia ­ Av. Reitor Miguel Calmon s/n ­ 40110-100 Salvador BA ­ Brasil.

*

Neurocisticercose: aspectos clínicos, epidemiológicos e diagnósticos. Estudo prospectivo de 157 pacientes na região nordeste ­ Estado da Bahia (Resumo). Tese de Doutorado, Universidade Federal Fluminense (Área: Neurologia). Orientador: Marcos Raimundo Gomes de Freitas.

Publication Dates

• Publication in this collection
  17 Nov 2000
• Date of issue
  Mar 1998