Brain echinococcosis — the disease caused by penetration into a brain of larvae of an ekhinokokk with formation of single or multiple cysts bubbles. Depending on an arrangement it is shown by headaches, epileptic attacks, paresis, sight violation, frustration of mentality. The basis for diagnosis of cerebral echinococcosis is existence of a cyst according to a tomography, the accruing caption of antiekhinokokkovy antibodies and positive test of Kasoni. Full removal of cysts with the capsule in combination with protivogelmintny and symptomatic therapy is carried out. After operation rehabilitation and long observation is required.
Brain echinococcosis — rare parasitic defeat of cerebral fabrics. According to various data, makes from 0,4 to 9% of all cases of echinococcosis. Damages of a brain in combination with echinococcosis of a liver and lungs occurs at 0,2% of patients. The greatest incidence is noted in endemic zones. For Russia it is Bashkiria, Tatarstan, Stavropol and Krasnodar Krai, northern regions. The majority of cases of cerebral echinococcosis is presented by the single bubbles containing larvae of a parasite. Multiple echinococcosis of a brain meet extremely seldom. The Ekhinokokkovy centers are localized mainly in white substance of parietal, frontal and occipital lobes.
The cerebral form of echinococcosis arises owing to penetration of larvae into brain fabrics. Infection of the person occurs in the alimentary way — at a proglatyvaniye of eggs (onkosfer) of an ekhinokokk. The last are allocated to the environment with excrements of the infected animals: wolves, dogs, foxes. It is long remain in the soil, with its dried-up parts (dust) carried by wind. Eggs can get on hair of a livestock and the dogs lying on a grass on clothes and hands of people. The faces tied with livestock production and cutting of hulks, hunters, owners of the dogs who are in free walking have the greatest risk of infection. The person sick with echinococcosis does not allocate parasites and is not dangerous to people around.
Obsemeneniye of food occurs generally through dirty hands. In endemic areas near slaughterhouses and livestock farms hit of dust with onkosfer of an ekhinokkok on the products standing openly is possible. Getting into intestines of the person, the larva leaves egg and gets into the vascular course. With blood current it passes through a liver and lungs. The hematogenic drift of a larva in a brain is possible if it "was not hooked" in fabrics of the previous bodies or at hit in an organism of a large number of eggs with the combined defeat of several bodies at once.
In brain fabrics around a larva of an ekhinokokk the fibrous capsule is formed. The bubble sometimes surrounded with an inflammatory zone — result of reaction of cerebral cages to introduction of an alien organism is formed. The cysts located close cerebral covers can be involved in inflammatory process. The center of echinococcosis renders irritant action on brain neurons that leads to emergence of epileptic attacks. Gradually ekhinokokkovy bubble increases in sizes, putting the increasing pressure upon surrounding fabrics.
There is intra cranial hypertensia — increase in pressure in a cranium. Increase of pressure affects all sites of a brain and is the cornerstone of the progressing all-brain symptoms. Cerebral fabrics and the vessels feeding them are squeezed. The chronic hypoxia and ischemia leading to violation of metabolism and death of neurons develop. First of all the nervous cages located around a cyst suffer. Loss of their functions is shown by focal neurologic symptomatology.
Echinococcosis of a brain includes 2 main forms. Different approaches in treatment are applied to each of them in practical neurology and neurosurgery. The forecast depends on a form of a disease.
- The solitary form is characterized by existence of a single cyst. Education often reaches the considerable sizes — to 60 mm in the diameter. In a clinical picture focal epipristupa and focal symptoms prevail. Perhaps radical surgical removal. Has rather favorable forecast.
- The Ratsimozny form differs in formation of a racemose conglomerate of bubbles and a mnogoochagovost of defeat. Meets seldom. In clinic heavy all-brain manifestations prevail. Surgical treatment is difficult.
Brain echinococcosis symptoms
The solitary cyst differs in gradual development of symptomatology. The disease begins with a periodic headache. Temples, a forehead or all head hurt. Pressure sense on eyes is characteristic. Duration and intensity of a tsefalgiya gradually increase. It gains persistent character, is followed by nausea and vomiting. At a number of patients echinococcosis debuts an epileptic paroxysm. Then there are headaches. Multiple cerebral defeats demonstrate a sharp likvorno-gipertenzionny syndrome with an intensive tsefalgiya and repeated vomiting.
Focal displays of a disease directly depend on an arrangement of an ekhinokokkovy bubble. Epileptic seizures which last several years are typical and will not respond to drug treatment. Paroxysms have character of focal epilepsy in the form of a sleep (a touch paroxysm) or convulsive muscular contractions (a motive paroxysm). In an attack it is involved one or both extremities of a half of a body, opposite localization of a cyst in a brain. Secondary generalization is possible: spasms develop in one extremity, gradually extend to all body. In the subsequent in the extremities subject to focal motive epipristupa, muscular weakness, spastic constraint develops, painful sensitivity is lost.
Various mental disorders (depression, aggression, nonsense), memory violation, decrease in mental abilities up to dementia occur among other focal manifestations. The picture of all-brain symptomatology is supplemented by the ataxy connected with defeat of the vestibular analyzer. Dizzinesses with feeling of rotation of surrounding objects, instability are observed during walking, disorder of coordination — at sharp turns of patients "brings" aside. Expressiveness and speed of progressing of symptoms varies depending on the place of defeat and speed of increase in volume of a cyst.
The intra cranial hypertensia accompanying echinococcosis causes a sdavleniye of a visual path and leads to an atrophy of optic nerves with visual acuity falling. The course of epilepsy, steady against antikonvulsantny therapy, at brain echinococcosis often is complicated by development of the epileptic status. The epipristupa following continuously one after another are life-threatening as they provoke failure in work of respiratory and cardiovascular system. In the absence of timely diagnosis and adequate treatment of cerebral echinococcosis the increasing cyst causes the shift of brain structures. The accruing hypertensia causes a brain sdavleniye with dysfunction of the vital nervous centers and the subsequent lethal outcome. A rare complication is the rupture of an ekhinokokkovy bubble with an obsemeneniye of surrounding fabrics.
Echinococcosis of a brain has a clinical picture similar to intracerebral tumors that quite often leads to diagnostic mistakes. Therefore consecutive implementation of all stages of complex diagnostics is important:
- Specification of the anamnesis. Helps to elicit the fact of stay in the area, endemic on echinococcosis, work in livestock economy, etc. Establishes features of the beginning of a disease.
- Survey of the neurologist. Reveals signs of the increased intra cranial pressure, focal symptomatology — existence of a hemiparesis, mental deviations, cognitive violations.
- Survey of the ophthalmologist. Provides carrying out an oftalmoskopiya by means of which edematous disks of optic nerves are found, and at it is long to the existing clinic — atrophy signs.
- Skull X-ray analysis. Manual vdavleniye on cranial bones, a divergence of seams between them, signs of expansion of diploichesky veins testify about is long the existing increase in intrakranialny pressure. At the same time the disease can have small duration.
- Tomographic researches. Allow to reveal intracerebral education with thin walls, to define its localization and volume. Brain KT more informatively concerning a kaltsinoz of the capsule, brain MRT visualizes cyst walls better.
- Laboratory analyses. In OAK there are no inflammatory changes, the eozinofiliya is observed. The immunofermental research on existence of antibodies to an ekhinokokk is conducted. The caption of antibodies matters: than he is higher, more likely confirms those echinococcosis.
- Allergoproba with an ekhinokokkovy anti-gene. Intracutaneous test of Kasoni in its modern interpretation (Schultz's method) is carried out. The positive result is noted at 85% of patients with cerebral echinococcosis.
- Inspection of other bodies. It is necessary for an exception of the combined defeat. Ultrasonography of a liver and a X-ray analysis of lungs is carried out. At detection change the in-depth study with purpose of MRT of a liver, KT of lungs, consultations of the hepatologist, pulmonologist, etc. is conducted.
The received results estimate in total, comparing them with clinical symptoms and the course of a disease. It is necessary to differentiate brain echinococcosis from other volume educations: arakhnoidalny cysts, cerebral cysticercosis, epidermoidny cysts, intrakranialny tumors and abscesses.
Treatment of echinococcosis of a brain
The most justified method of treatment is surgical. Today it is effectively combined with etiotropny, symptomatic and rehabilitation therapy. Complex treatment is performed by a number of experts and includes:
- Surgical removal of a cyst. As the standard standard radical microsurgical excision without damage of walls of a bubble acts. Operation demands from the neurosurgeon of careful planning of access. At localization of defeat in functionally significant areas of a brain the intraoperative kortikografiya is carried out. The difficult task is represented by treatment of the multiple centers as removal of all cysts is necessary.
- Conservative etiotropny therapy which is carried out by protivogelmintny pharmaceuticals from group of benzimidazoles (for example, albendazoly). Earlier antigelmintny treatment was appointed in inoperable cases and had palliative character. Positive influence of postoperative antigelmintny therapy on efficiency of surgical treatment is lately proved.
- Symptomatic treatment is performed within preoperative and recovery therapy. It is carried out by antikonvulsant, the medicines reducing intra cranial pressure, anesthetics, etc.
- The postoperative rehabilitation consisting of pharmacotherapy (medicines for improvement of cerebral metabolism and a blood-groove), physiotherapy exercises, psychotherapy and occupations with the logopedist (at violations of the speech).
Forecast and prevention
The forecast depends on a form of a disease, quantity, the sizes and localization of ekhinokokkovy bubbles. The optimum forecast has in due time operated solitary cerebral echinococcosis. Frequency of a postoperative recurrence makes 15-30%. The recurrence arises if during operation there was an opening of a bubble. But mainly it is caused by ability of a parasite to extend the microscopic eliminations which are not diagnosed by modern ways of neurovisualization out of capsule limits.
For the purpose of timely diagnostics of a recurrence the operated patients have to undergo the regular inspections including the analysis on antibodies, ultrasonography of a liver, cerebral MRT, a X-ray analysis of OGK. The term of observation of patients recommended to WHO — 10 years. To the actions capable to warn echinococcosis, observance of rules of personal hygiene, wearing overalls during the work with animals and cutting of hulks, increase in a sanitary condition of farms, identification and elimination of a source of infection belongs.