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Imaging aspects of the racemose neurocysticercosis.

Machado DC, Camilo GB, Alves UD, de Oliveira CE, de Oliveira RV, Lopes AJ - Arch Med Sci (2015)

View Article: PubMed Central - PubMed

Affiliation: Postgraduate Program in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Radiology, State University of Rio de Janeiro, Rio de Janeiro, Brazil.

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Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system (CNS)... During the epileptic seizures, the α rhythm was maintained, indicating that there was not complete loss of consciousness (only compromised consciousness)... High-resolution CT (HRCT) with the administration of iodinated contrast medium revealed small rounded lesions, which were well-defined, grouped, presented a ‘grape-cluster’ appearance and were located at the cortical-subcortical region of the left frontal lobe (superior and middle gyri)... There was ring enhancement of the contrast medium associated with significant perilesional edema, as well as effacement of the adjacent cortical sulci and the corresponding lateral ventricle which caused contralateral deviation from the midline at approximately 0.8 cm... In this form, a discrete chronic inflammatory reaction occurs... In the racemose form, the cysticerci are located at the basal cisterns or the ventricular and subarachnoid spaces and usually present a multilobular vesicular form with a mass effect... Computed tomography and MRI provide objective evidence concerning the number, topography and involution stage of the lesions... Cystic lesions located within the cerebrospinal fluid cisterns usually have a multilobular appearance, tend to displace neighboring structures and behave as lesions with a mass effect... According to an evolutionary point of view, parenchymal NCC may be divided into the following four stages: (1) the vesicular stage, characterized by the presence of a scolex within the cyst and the absence of enhancement of the cyst wall; (2) the colloidal vesicular stage, characterized by thick fluid inside the cyst, a ring-enhancing lesion and loss of scolex; (3) the granular nodular stage, characterized by enhancement of the nodular lesion or a small ring-enhancing lesion; and (4) the nodular calcified stage, in which small, calcified granulomatous lesions can be seen... However, if the scolex is not detected, the following alternative features should be considered: widened perivascular spaces and neuroglial cysts in cases involving intraparenchymal lesions; ependymal cysts and choroid plexus cysts at intraventricular sites; and subarachnoid cysts and epidermoid cysts at other extra-axial locations... In the granular nodular stage of NCC, the main imaging characteristics for differential diagnosis include early stage granulomatous diseases and metastases that present as contrast-enhanced nodular lesions... Finally, in the nodular calcified stage, late-stage granulomatous disease and tuberous sclerosis are the main conditions that should be considered in differential diagnoses of NCC... In conclusion, the present case report describes a rare form of NCC... The lesions extended from the periventricular region to the cortical-subcortical interface, indicating a case of racemose NCC with an atypical location that was in the most chronic stage of the disease.

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Related in: MedlinePlus

Magnetic resonance images of the skull with FLAIR- (A), T2*- (B), T2- (C) and T1- weighted sequences (D) following the intravenous administration of gadolinium. The sequence of images shows multinodular intra-axial lesions with a ‘grape-cluster’ appearance, which were isointense and demonstrated markedly hypointense halos on T2 and an intermediate signal with intense enhancement on T1. These lesions were located in the left frontal lobe and cortical-subcortical region. There was intense perilesional edema with a fronto-parietal distribution
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Figure 0002: Magnetic resonance images of the skull with FLAIR- (A), T2*- (B), T2- (C) and T1- weighted sequences (D) following the intravenous administration of gadolinium. The sequence of images shows multinodular intra-axial lesions with a ‘grape-cluster’ appearance, which were isointense and demonstrated markedly hypointense halos on T2 and an intermediate signal with intense enhancement on T1. These lesions were located in the left frontal lobe and cortical-subcortical region. There was intense perilesional edema with a fronto-parietal distribution

Mentions: Two days after HRCT, magnetic resonance imaging (MRI) was performed to obtain T1-, T2-, T2*- and fluid-attenuated inversion recovery (FLAIR)-weighted sequences before and after the use of contrast medium. These images showed multinodular intra-axial lesions located at the left frontal lobe and the cortical-subcortical region, which were isointense and presented markedly hypointense halos on T2 and an intermediate signal and intense enhancement on T1. There was also severe perilesional edema with a fronto-parietal distribution (Figure 2). These imaging aspects were again consistent with racemose NCC.


Imaging aspects of the racemose neurocysticercosis.

Machado DC, Camilo GB, Alves UD, de Oliveira CE, de Oliveira RV, Lopes AJ - Arch Med Sci (2015)

Magnetic resonance images of the skull with FLAIR- (A), T2*- (B), T2- (C) and T1- weighted sequences (D) following the intravenous administration of gadolinium. The sequence of images shows multinodular intra-axial lesions with a ‘grape-cluster’ appearance, which were isointense and demonstrated markedly hypointense halos on T2 and an intermediate signal with intense enhancement on T1. These lesions were located in the left frontal lobe and cortical-subcortical region. There was intense perilesional edema with a fronto-parietal distribution
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4697069&req=5

Figure 0002: Magnetic resonance images of the skull with FLAIR- (A), T2*- (B), T2- (C) and T1- weighted sequences (D) following the intravenous administration of gadolinium. The sequence of images shows multinodular intra-axial lesions with a ‘grape-cluster’ appearance, which were isointense and demonstrated markedly hypointense halos on T2 and an intermediate signal with intense enhancement on T1. These lesions were located in the left frontal lobe and cortical-subcortical region. There was intense perilesional edema with a fronto-parietal distribution
Mentions: Two days after HRCT, magnetic resonance imaging (MRI) was performed to obtain T1-, T2-, T2*- and fluid-attenuated inversion recovery (FLAIR)-weighted sequences before and after the use of contrast medium. These images showed multinodular intra-axial lesions located at the left frontal lobe and the cortical-subcortical region, which were isointense and presented markedly hypointense halos on T2 and an intermediate signal and intense enhancement on T1. There was also severe perilesional edema with a fronto-parietal distribution (Figure 2). These imaging aspects were again consistent with racemose NCC.

View Article: PubMed Central - PubMed

Affiliation: Postgraduate Program in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Radiology, State University of Rio de Janeiro, Rio de Janeiro, Brazil.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system (CNS)... During the epileptic seizures, the α rhythm was maintained, indicating that there was not complete loss of consciousness (only compromised consciousness)... High-resolution CT (HRCT) with the administration of iodinated contrast medium revealed small rounded lesions, which were well-defined, grouped, presented a ‘grape-cluster’ appearance and were located at the cortical-subcortical region of the left frontal lobe (superior and middle gyri)... There was ring enhancement of the contrast medium associated with significant perilesional edema, as well as effacement of the adjacent cortical sulci and the corresponding lateral ventricle which caused contralateral deviation from the midline at approximately 0.8 cm... In this form, a discrete chronic inflammatory reaction occurs... In the racemose form, the cysticerci are located at the basal cisterns or the ventricular and subarachnoid spaces and usually present a multilobular vesicular form with a mass effect... Computed tomography and MRI provide objective evidence concerning the number, topography and involution stage of the lesions... Cystic lesions located within the cerebrospinal fluid cisterns usually have a multilobular appearance, tend to displace neighboring structures and behave as lesions with a mass effect... According to an evolutionary point of view, parenchymal NCC may be divided into the following four stages: (1) the vesicular stage, characterized by the presence of a scolex within the cyst and the absence of enhancement of the cyst wall; (2) the colloidal vesicular stage, characterized by thick fluid inside the cyst, a ring-enhancing lesion and loss of scolex; (3) the granular nodular stage, characterized by enhancement of the nodular lesion or a small ring-enhancing lesion; and (4) the nodular calcified stage, in which small, calcified granulomatous lesions can be seen... However, if the scolex is not detected, the following alternative features should be considered: widened perivascular spaces and neuroglial cysts in cases involving intraparenchymal lesions; ependymal cysts and choroid plexus cysts at intraventricular sites; and subarachnoid cysts and epidermoid cysts at other extra-axial locations... In the granular nodular stage of NCC, the main imaging characteristics for differential diagnosis include early stage granulomatous diseases and metastases that present as contrast-enhanced nodular lesions... Finally, in the nodular calcified stage, late-stage granulomatous disease and tuberous sclerosis are the main conditions that should be considered in differential diagnoses of NCC... In conclusion, the present case report describes a rare form of NCC... The lesions extended from the periventricular region to the cortical-subcortical interface, indicating a case of racemose NCC with an atypical location that was in the most chronic stage of the disease.

No MeSH data available.


Related in: MedlinePlus