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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2016; 74(06): 495-500
DOI: 10.1590/0004-282X20160054
VIEW AND REVIEW

Neurocysticercosis, familial cerebral cavernomas and intracranial calcifications: differential diagnosis for adequate management

Neurocisticose, cavernoma cerebral familiar e calcificações intracranianas: diagnóstico diferencial e acompanhamento adequado
Emerson Leandro Gasparetto
1   Universidade Federal do Rio de Janeiro, Departamento de Radiologia, Rio de Janeiro RJ, Brazil;
,
Soniza Alves-Leon
2   Universidade Federal do Estado do Rio de Janeiro, Departamento de Neurologia, Programa de Epilepsias, Rio de Janeiro RJ, Brazil;
,
Flavio Sampaio Domingues
3   Universidade Federal do Rio de Janeiro, Departamento de Neurocirurgia, Rio de Janeiro RJ, Brazil;
,
João Thiago Frossard
3   Universidade Federal do Rio de Janeiro, Departamento de Neurocirurgia, Rio de Janeiro RJ, Brazil;
,
Selva Paraguassu Lopes
4   Aliança Cavernoma Brasil, Brasília DF, Brazil.
,
Jorge Marcondes de Souza
3   Universidade Federal do Rio de Janeiro, Departamento de Neurocirurgia, Rio de Janeiro RJ, Brazil;
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ABSTRACT

Neurocysticercosis (NCC) is an endemic disease and important public health problem in some areas of the World and epilepsy is the most common neurological manifestation. Multiple intracranial lesions, commonly calcified, are seen on cranial computed tomography (CT) in the chronic phase of the disease and considered one of the diagnostic criteria of the diagnosis. Magnetic resonance imaging (MRI) is the test that better depicts the different stages of the intracranial cysts but does not show clearly calcified lesions. Cerebral cavernous malformations (CCM), also known as cerebral cavernomas, are frequent vascular malformations of the brain, better demonstrated by MRI and have also epilepsy as the main form of clinical presentation. When occurring in the familial form, cerebral cavernomas typically present with multiple lesions throughout the brain and, very often, with foci of calcifications in the lesions when submitted to the CT imaging. In the countries, and geographic areas, where NCC is established as an endemic health problem and neuroimaging screening is done by CT scan, it will be important to consider the differential diagnosis between the two diseases due to the differences in adequate management.

RESUMO

A neurocisticercose (NCC) é um importante problema endêmico de saúde pública em algumas áreas do mundo, sendo epilepsia sua manifestação clínica mais comum. Múltiplas lesões intracranianas, geralmente com calcificações visualizadas em tomografia computorizada de crânio, são interpretadas como um dos critérios diagnósticos na fase crçnica da doença. A ressonância magnética é o melhor teste de imagem para identificar a doença em diferentes estágios de sua forma cística mas apresenta limitações para demonstrar lesões calcificadas. Malformações cavernosas cerebrais, ou cavernomas, são malformações vasculares comuns ao sistema nervoso e epilepsia é também a sua forma mais frequente de apresentação. Na sua forma familiar cavernomas apresentam-se tipicamente com múltiplas lesões encefálicas e, frequentemente, com focos de calcificações na TC. Em alguns países, e determinadas regiões geográficas, onde neurocisticercose é endêmica, a neuroimagem mais usada para diagnóstico é a TC de crânio. Nesse contexto torna-se importante estabelecer bases para o diagnóstico diferencial entre as duas doenças, devido às diferentes formas de acompanhamento e tratamento adequado.

neurocysticercosis - epilepsy - cavernomas - familial cerebral cavernous malformation - computerized tomography - magnetic resonance
neurocisticercose - epilepsia - malformação cavernosa cerebral familiar - cavernoma cerebral - tomografia computorizada - ressonância magnética


Publication History

Received: 02 September 2015

Accepted: 22 December 2015

Article published online:
06 September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Carpio A. Neurocysticercosis: an update. Lancet Infect Dis 2002;2(12):751-62. doi:10.1016/S1473-3099(02)00454-1
  • 2 Fabiani S, Bruschi F. Neurocysticercosis in Europe: still a public health concern not only for imported cases. Acta Trop. 2013;128(1):18-26. doi:10.1016/j.actatropica.2013.06.020
  • 3 Carpio A, Romo M. The relationship between neurocysticercosis and epilepsy: an endless debate. Arq Neuropsiquiatr. 2014:72(5):383-90. doi:10.1590/0004-282X20140024
  • 4 Carpio A, Placenua M. Definition of contemporary surgical management in cisternal and parenchymatous cysticercosis cerebri. Neurosurgery. 1992;30(6):968-9. doi:10.1227/00006123-199206000-00035
  • 5 Santos GT, Leite CC, Machado LR, McKinney AM, Lucato LT. Reduced diffusion in neurocysticercosis: circumstances of appearance and possible natural history implications. AJNR Am J Neuroradiol. 2013;34(2):310-6. doi:10.3174/ajnr.A3198
  • 6 Thurman DJ, Beghi E, Begley CE, Berg AT, Buchhalter JR, Ding D et al. Standards for epidemiologic studies and surveillance of epilepsy. Epilepsia. 2011;52 Suppl 7:S2-26. doi:10.1111/j.1528-1167.2011.03121.x
  • 7 Carabin H, Ndimubanzi PC, Budke CM, Nguyen H, Qian Y, Cowan LD et al. Clinical manifestations associated with neurocysticercosis: a systematic review. PLoS Negl Trop Dis. 2011;5(5):e1152. doi:10.1371/journal.pntd.0001152
  • 8 Machado LR. The diagnosis of neurocysticercosis: a closed question? Arq Neuropsiquiatr. 2010;68(1):1-2. doi:10.1590/S0004-282X2010000100001
  • 9 Garcia HH, Nash TE, Del Brutto OH. Clinical symptoms, diagnosis and treatment of neurocysticercosis. Lancet Neurol. 2014;13(12):1202-15. doi:10.1016/S1474-4422(14)70094-8
  • 10 Montano SM, Villaran MV, Ylquimiche L, Figueroa JJ, Rodriguez S, Bautista CT et al. Neurocysticercosis association between seizures, serology and brain CT in rural Peru. Neurology. 2005;65(2):229-33. doi:10.1212/01.wnl.0000168828.83461.09
  • 11 Medina MT, Rosas E, Rubio-Donnadieu F, Sotelo J. Neurocysticercosis as the main cause of late-onset epilepsy in Mexico. Arch Intern Med. 1990;150(2):325-7. doi:10.1001/archinte.1990.00390140065014
  • 12 Singh G, Singh P, Singh I, Rani A, Kaushal S, Avasthi G. Epidemiologic classification of seizures associated with neurocysticercosis: observations from a sample of seizure disorders in neurologic care in India. Acta Neurol Scand. 2006;113(4):233-40. doi:10.1111/j.1600-0404.2005.00575.x
  • 13 Batra S, Lin D, Recinos PF, Zhang J, Rigamonti D. Cavernous malformations: natural history, diagnosis and treatment. Nat Rev Neurol. 2009;5(12):659-70. doi:10.1038/nrneurol.2009.177
  • 14 Gross BA, Lin N, Du R, Day AL. The natural history of intracranial cavernous malformations. Neurosurg Focus 2011;30(6):E24. doi: 10.3171/2011.3.FOCUS1165
  • 15 Al-Shahi Salman R, Hall JM, Horne MA, Moultrie F, Josephson CB, Bhattacharya JJ et al. Untreated clinical course of cerebral cavernous malformations: a prospective, population-based cohort study. Lancet Neurol. 2012;11(3):217-24. doi:10.1016/S1474-4422(12)70004-2
  • 16 Labauge P, Denier C, Bergametti F, Tournier-Lasserve E. Genetics of cavernous angiomas. Lancet Neurol. 2007;6(3):237-44. doi:10.1016/S1474-4422(07)70053-4
  • 17 Mondéjar R, Solano F, Rubio R, Delgado M, Pérez-Sempere A, González-Meneses A et al. Mutation prevalence of cerebral cavernous malformation genes in Spanish patients. PLOS One. 2014;9(1):e86286. doi:10.1371/journal.pone.0086286
  • 18 Riant F, Cecillon M, Saugier-Veber P, Tournier-Lasserve E. CCM molecular screening in a diagnosis context: novel unclassified variants leading to abnormal splicing and importance of large deletions. Neurogenetics. 2013;14(2):133-41. doi:10.1007/s10048-013-0362-0
  • 19 Morrison L. Genetic counselling. In: Rigamonti D, editor. Cavernous malformation of the nervous system. Cambridge: Cambridge University Press; 2011. p. 181-3.
  • 20 Choquet H, Pawlikowska L, Nelson J, McCulloch CE et al. Polymorphisms in inflammatory and immune response genes associated with cerebral cavernous malformation type 1 severity. Cerebrovasc Dis, 2014;38(6):433-40. doi:10.1159/000369200
  • 21 Domingues F, Gasparetto EL, Andrade R, Noro F, Eiras A, Gault J et al. Familial cerebral cavernous malformations: Rio de Janeiro study and review of the recommendations for management. Arq Neuropsiquiatr. 2008;66(4):795-9. doi:10.1590/S0004-282X2008000600003
  • 22 Shenkar R, Shi C, Rebeiz T, Stockton RA, McDonald DA, Mikati AG et al. Exceptional aggressiveness of cerebral cavernous malformation disease associated with PDCD10 mutations. Genet Med. 2015;17(3):188-96. doi: 10.1038/gim.2014.97
  • 23 Salman RA. The outlook for adults with epileptic seizures associated with cerebral cavernous malformations or arteriovenous malformations. Epilepsia. 2012;53(Suppl 4):34-42. doi:10.1111/j.1528-1167.2012.03611.x
  • 24 Rosenow F, Alonso-Vanegas MA, Baumgartner C, Blümcke I, Carreño M, Gizewski ER et al. Cavernoma-related epilepsy: review and recommnedations for management. Report of the Surgical Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2013;54(12):2025-35. doi:10.1111/epi.12402
  • 25 Englot DJ, Han SJ, Lawton MT, Chang EF. Predictors of seizure freedom in the surgical treatment of supratentorial cavernous malformations. J Neurosurg. 2011;115(6):1169-74. doi:10.3171/2011.7.JNS11536
  • 26 Clatterbuck RE, Eberhart CG, Crain BJ, Rigamonti D. Ultrastructural and immunocytochemical evidence that an incompetent blood-brain barrier is related to the pathophysiology of cavernous malformations. J Neurol Neurosurg Psychiatry. 2001;71(2):188-92. doi:10.1136/jnnp.71.2.188
  • 27 Awad I, Jabbour P. Cerebral cavernous malformations and epilepsy. Neurosurg Focus. 2006;21(1):e7. doi:10.3171/foc.2006.21.1.8
  • 28 Goodman KA, Ballagh SA, Carpio A. Case-control study of seropositivity for cysticercosis in Cuenca, Ecuador. Am J Med Hyg. 1999;60(1):70-4.
  • 29 Lucato LT, Guedes MS, Sato JR, Bacheschi LA, Machado LR, Leite CC. The role of conventional MR imaging sequences in the evaluation of neurocysticercosis: impact on characterization of the scolex and lesion burden. AJNR Am J Neuroradiol, 2007;28(8):1501-4. doi:10.3174/ajnr.A0623
  • 30 Santos GT, Leite CC, Machado LR, McKinney AM, Lucato LT. Reduced diffusion in neurocysticercosis: circunstances of appearance and possible natural history implications. AJNR Am J Neuroradiol. 2013;34(2):310-6. doi:10.3174/ajnr.A3198
  • 31 Batra S, Crain B, EngelmannR, Camara-Quintana J, Rigamonti D. Pathology of cavernous malformations. In: Rigamonti D, editor. Cavernous malformation of the nervous system. Cambridge: Cambridge University Press; 2011. p 1-7.
  • 32 Lin DDM, Abdalla W. Neuroimaging of cavernous malformation. In: Rigamonti D, editor. Cavernous malformation of the nervous system. Cambridge: Cambridge University Press; 2011. p. 49-63.
  • 33 Souza JM, Domingues RC, Cruz LC Jr, Domingues FS, Iasbeck T, Gasparetto EL. Susceptiblility-weighted imaging for the evaluation of patients with familial cerebral cavernous malformations: a comparison with T2-weighted fast spin-echo and gradient-echo sequences. AJNR Am J Neuroradiol. 2008;29(1):154-8. doi:10.3174/ajnr.A0748
  • 34 Fleury A, Escobar A, Fragoso G, Sciutto E, Larralde C. Clinical heterogeneity of human neurocysticercosis results from complex interactions among parasytes, host and environmental factors. Trans R Soc Trop Med Hyg. 2010;104(4):243-50. doi:10.1016/j.trstmh.2010.01.005
  • 35 Leigh R, Wityk RJ. Special problems in cavernous malformations: migraine, pregnancy, hormonal replacement, anticoagulation, NSAIDS, and altitude elevation. In: Rigamonti D, editor. Cavernous malformation of the nervous system. Cambridge: Cambridge University Press; 2011. p. 185-9.
  • 36 Berg MJ, Vay T. Clinical features and medical management of cavernousmalformations. In: Rigamonti D, editor. Cavernous malformation of the nervous system. Cambridge: Cambridge University Press; 2011. p. 65-78.