背景:神经囊虫病(NCC)是世界范围内中枢神经系统最常见的寄生虫感染,是由tape虫的幼虫形式引起的。总的来说,T.solium幼虫形式可能位于神经轴中,导致病理学。这里,我们报告了一例罕见的女性病例,有成人发作性癫痫发作史,在第四脑室表现为成人T.solium。导致脑积水.
方法:一名36岁女性患者,已知有成人发作性癫痫发作史,有1年的双侧头痛逐渐恶化,伴有眩晕和间歇性恶心。计算机断层扫描显示脑室增宽和室管膜血流,第四脑室水平有阻塞.门诊磁共振成像显示梗阻性脑积水继发于第四脑室内的小叶囊性肿块,表现出与总状NCC一致的粗糙外观。患者接受了内镜下第三脑室造瘘术,对切除的囊肿进行粗略检查,发现成熟的T.solium幼虫包裹在囊膜中。鉴于我们的患者在墨西哥出生并长大,但自8岁起就没有返回,因此NCC是一个意外发现。
结论:本病例强调了在所有出现不明原因癫痫发作或脑积水的患者中保持高度怀疑NCC的重要性。即使是在流行国家居住历史非常遥远的患者,NCC可以被忽视,两种慢性神经症状的根本原因,以及急性,危及生命的神经急症.
BACKGROUND: Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system worldwide and is caused by the larval form of the
tapeworm Taenia solium. In general, T. solium larval form may be located in the neuraxis, resulting in pathology. Here, we report a rare
case of female with a history of adult onset seizures presenting with adult form T. solium in the fourth ventricle, causing hydrocephalus.
METHODS: A 36-year-old female patient with a known history of adult onset seizures presented with a 1-year history of progressively worsening bilateral headaches with vertigo and intermittent nausea. A computerized tomography scan revealed ventriculomegaly and transependymal flow, with an obstruction at the level of the fourth ventricle. Outpatient magnetic resonance imaging demonstrated obstructive hydrocephalus secondary to a lobulated cystic mass within the fourth ventricle, demonstrating a gross appearance consistent with racemose NCC. The patient underwent endoscopic third ventriculostomy, and gross examination of the resected cyst revealed a mature T. solium larvae encased in a cystic membrane. Given that our patient was born and raised in Mexico but had not returned since the age of 8, NCC was an unexpected finding.
CONCLUSIONS: The present
case highlights the importance of maintaining high suspicion for NCC in all patients presenting with seizures or hydrocephalus of unknown cause. Even in patients with a very remote history of residence in an endemic country, NCC can be an overlooked, underlying cause of both chronic neurologic symptoms, as well as acute, life-threatening neurologic emergencies.