Brain cysticercosis — the parasitic damage of a brain developing at hit in a human body of larvae of a pork tapeworm. Focal epileptic attacks, intra cranial hypertensia with crises, mental deviations are clinically noted. Small neurologic deficiency is possible. The diagnosis is established by means of an oftalmoskopiya, blood test and a likvor, cerebral KT or MPT, an electroencephalography. Treatment complex and long with use of protivogelmintny and antiepileptic medicines, dehydrating and resolvents.
Brain cysticercosis — the separate form of helminthosis arising at penetration into cerebral fabrics of larvae of a pork tapeworm and education — larval bubbles with a helminth head inside. About 60% of cysticercosis are connected with damage of a brain. Also damage of eyes and skeletal muscles meets. Among cerebral structures cerebral covers of the basis, the surface of brain bark, brain ventricles are most subject to penetration of larvae.
On a global scale the greatest incidence is observed in Asia, Latin America and Africa. Cysticercosis of a brain is widespread in our country in territories with the developed pig-breeding. Adults are ill more often than children. Gender distinctions in incidence are not found. In modern neurology timely detection and treatment of cerebral cysticercosis has great practical value as widespread damages of a brain tsistitserka can lead to a lethal outcome.
Brain cysticercosis reasons
At hit the intestinal form of helminthosis — develops in a human body of tsistitserok, and at penetration of larvae of a pork tapeworm — cysticercosis. Will catch larvae it is possible through dirty hands from the patient teniozy the person or a pig, and also when eating of the infected pork. When larvae in covers it appears in a stomach of the person, their covers collapses under the influence of gastric juice. Larvae are soaked up in blood and can be brought by its current in a brain, eyes, muscles. At penetration into a brain the larva turns in with a diameter of 3-15 mm. She can live in such look up to 30 years. If the larva perishes, there is a calcification a tsistitserka.
In rare instances in brain fabrics single tsistitserka which can not give clinical symptomatology are found. But more often defeat has multiple character and is followed by the expressed symptomatology caused, first of all, by irritation of cerebral fabrics in the place of localization of parasites. In response to penetration of larvae inflammatory process which is followed by hyperproduction of tserebrospinalny liquid with developing of hydrocephaly develops. Besides, in the course of activity larval bubbles emit substances, toxic for brain cages. Thus, defeat at cysticercosis of a brain has 3 components: irritation, inflammation and toxic influence. Even calciphied tsistitserka continue to support a chronic inflammation of cerebral fabrics.
Brain cysticercosis symptoms
In clinic symptoms of irritation and likvorny hypertensia prevail. As a rule, the irritation leads to emergence of epileptic paroxysms. As damage of a brain has focal character, are observed by Epi paroxysms, characteristic of symptomatic focal epilepsy. These are partial simple and difficult epipristupa, it is possible with secondary generalization and transition to the epileptic status. Most often cysticercosis of a brain proceeds with attacks of dzheksonovsky epilepsy. Polymorphism of the last (a combination of motor and touch paroxysms to various clinic) testifies to the multiple centers of cysticercosis in cerebral bark.
Intra cranial hypertensia is shown by likvorno-gipertenzionny crises with paroxysms of an intensive tserebralgiya (headache) which is followed by vomiting and dizziness. At most of the patients having cysticercosis of a brain various deviations in the mental sphere are observed: from easy neurotic symptoms to heavy mental disorders (a depression, aggression, nonsense, a hallucinatory syndrome, etc.).
As tsistitserka have mainly small sizes, the symptomatology of loss of neurologic functions can be absent or is expressed slightly. Neurologic deficiency is presented by slight paresis, small speech disturbance, insignificant touch violations.
Cysticercosis of a brain differs in a long remittiruyushchy current. Deteriorations in a state alternate with the "light" periods which can take several months or even years. Cases of spontaneous treatment were not observed.
Clinic of cysticercosis of a brain depending on its localization
At defeat of a cover in the field of the basis of a brain the meningitis picture with bradycardia and damage of craniocereberal nerves prevails. According to an involvement of nerves are observed: sight violations, squint and central paresis of a facial nerve. At penetration of larvae into cerebral ventricles, tsistitserka freely float in tserebrospinalny liquid and can periodically cause occlusion of ways of outflow of a likvor, provoking heavy likvorno-gipertenzionny crisis. The symptomatology is in many respects similar to tumors of a brain of similar localization.
Cysticercosis of the IV ventricle is followed by clinic of a syndrome of Bruns — a paroxysm of a sharp tsefalgiya and vomiting with disorder of cardiovascular activity and breath. The syndrome is a consequence of irritation of a bottom of a ventricle or obturation of its opening a tsistetserok. At defeat of a side ventricle the attacks of disorder of consciousness caused by an obturation of the opening connecting it to the III ventricle are noted.
Diagnosis of cysticercosis of a brain
It is hard to establish brain cysticercosis. It is possible to suspect a disease on prevalence of symptoms of irritation, the polymorphism of symptomatology indicating a poliochagovost of cerebral defeat, a small proyavlennost of neurologic deficiency, to a remittiruyushchy current with the long periods of remission. The focal nature of epileptogenny activity is confirmed by data of an electroencephalography. During diagnostic search cysticercosis of a brain is differentiated from epilepsy, intra cranial tumors, meningitis of other etiology, encephalitis, neurosyphilis and so forth.
After the neurologist of ichesky inspection the neurologist directs patients to consultation to the ophthalmologist. Stagnant disks of optic nerves at an oftalmoskopiya testify to chronic intra cranial hypertensia. Sometimes at an eye bottom tsistitserka come to light.
Often cysticercosis of a brain is followed by the raised organism sensitization that is shown by an eozinofiliya in the general blood test. The research of tserebrospinalny liquid reveals with prevalence of lymphocytes and eosinophils, increase in concentration of protein is possible. In some cases pieces of capsules of tsistitserok come to light.
Congestions of tsistitserok in the form of a bunch or separate tsistitserka are visualized by means of brain KT or MPT as focal educations. Calciphied tsistitserka are found on a skull X-ray analysis in the form of melkoochagovy shadows. Precisely it is possible to establish an etiology of the revealed educations only by means of specific immunological researches (RSK, IFA, RIF) of blood or a likvor.
Treatment of cysticercosis of a brain
Therapy is carried out permanently and includes expulsion of helminths, fight in the increased intra cranial pressure, anti-inflammatory and anticonvulsive treatment. Expulsion of helminths is carried out prazikvantely and albendazoly. Against the background of such therapy deterioration in a condition of the patient and increase in number of Epi paroxysms is possible that is caused by destruction of tsistitserok and intoxications of cerebral fabrics disintegration products. During this period effectively additional purpose of anti-inflammatory medicines, including glucocorticosteroids.
For the purpose of knocking over of intra cranial hypertensia use diuretics (furosemide, acetazoleamide). Antikonvulsantny therapy is carried out by one of antiepileptic medicines (carbamazepine, diazepam, valproyevy to - that etc.). However its result depends on success of treatment of cysticercosis.
Surgical treatment is possible at rather large single tsistitserka, defeat of the IV ventricle with danger of occlusion, development by a rack of focal epilepsy with accurate localization of the epileptogenny center. The focal resection of a brain in such cases at most of patients leads to recovery.
Forecast and prevention of cysticercosis of a brain
The forecast is most serious if cysticercosis of a brain has polyfocal character or is followed by penetration of tsistitserok into the IV ventricle. The lethal outcome is possible during the epileptic status or an attack of hydrocephaly, owing to occlusion of outflow of a likvor from a cavity of the IV ventricle. Often long and repeated courses of the combined therapy are necessary for full treatment. Even after treatment of helminthosis at patients can remain: persistent intra cranial hypertensia, focal epilepsy, some deviations in the mental sphere.
The best warning facility of cysticercosis of a brain is a careful personal hygiene and the use only of the pork checked by veterinary and sanitary examination. With the preventive purpose examination of the persons occupied in pig-breeding and meat processing, timely identification of sick animals, epidemiological surveillance in the meat markets is conducted.