Parasitoses of the human central nervous system

2012 ◽  
Vol 87 (3) ◽  
pp. 257-270 ◽  
Author(s):  
J. Finsterer ◽  
H. Auer
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Trichinella Spiralis ◽  
Taenia Solium ◽  
Toxocara Canis ◽  
Neurological Deficits ◽  
Diagnostic Tools ◽  
Surgery Outcome ◽  
The Central Nervous System ◽  
Spirometra Mansoni

AbstractCerebral involvement in parasitoses is an important clinical manifestation of most of the human parasitoses. Parasites that have been described to affect the central nervous system (CNS), either as the dominant or as a collateral feature, include cestodes (Taenia solium (neurocysticerciasis), Echinococcus granulosus (cerebral cystic echinococcosis), E. multilocularis (cerebral alveolar echinococcosis), Spirometra mansoni (neurosparganosis)), nematodes (Toxocara canis and T. cati (neurotoxocariasis), Trichinella spiralis (neurotrichinelliasis), Angiostrongylus cantonensis and A. costaricensis (neuroangiostrongyliasis), Gnathostoma spinigerum (gnathostomiasis)), trematodes (Schistosoma mansoni (cerebral bilharziosis), Paragonimus westermani (neuroparagonimiasis)), or protozoa (Toxoplasma gondii (neurotoxoplasmosis), Acanthamoeba spp. or Balamuthia mandrillaris (granulomatous amoebic encephalitis), Naegleria (primary amoebic meningo-encephalitis), Entamoeba histolytica (brain abscess), Plasmodium falciparum (cerebral malaria), Trypanosoma brucei gambiense/rhodesiense (sleeping sickness) or Trypanosoma cruzi (cerebral Chagas disease)). Adults or larvae of helminths or protozoa enter the CNS and cause meningitis, encephalitis, ventriculitis, myelitis, ischaemic stroke, bleeding, venous thrombosis or cerebral abscess, clinically manifesting as headache, epilepsy, weakness, cognitive decline, impaired consciousness, confusion, coma or focal neurological deficits. Diagnosis of cerebral parasitoses is dependent on the causative agent. Available diagnostic tools include clinical presentation, blood tests (eosinophilia, plasmodia in blood smear, antibodies against the parasite), cerebrospinal fluid (CSF) investigations, imaging findings and occasionally cerebral biopsy. Treatment relies on drugs and sometimes surgery. Outcome of cerebral parasitoses is highly variable, depending on the effect of drugs, whether they are self-limiting (e.g. Angiostrongylus costaricensis) or whether they remain undetected or asymptomatic, like 25% of neurocysticerciasis cases.

Amiloride Alleviates Neurological Deficits Following Transient Global Ischemia and Engagement of Central IL-6 and TNF-α Signal

2019 ◽  
Vol 19 (8) ◽  
pp. 597-604
Author(s):  
Li Pang ◽  
Shouqin Ji ◽  
Jihong Xing
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Caspase 3 ◽  
Global Ischemia ◽  
Neurological Deficits ◽  
Global Cerebral Ischemia ◽  
Caspase 9 ◽  
Tnf Α ◽  
The Central Nervous System ◽  
Transient Global Ischemia

Background: Central pro-inflammatory cytokine (PIC) signal is involved in neurological deficits after transient global ischemia induced by cardiac arrest (CA). The present study was to examine if blocking acid sensing ion channels (ASICs) using amiloride in the Central Nervous System can alleviate neurological deficits after the induction of CA and further examine the participation of PIC signal in the hippocampus for the effects of amiloride. Methods: CA was induced by asphyxia and then cardiopulmonary resuscitation was performed in rats. Western blot analysis and ELISA were used to determine the protein expression of ASIC subunit ASIC1 in the hippocampus, and the levels of PICs. As noted, it is unlikely that this procedure is clinically used although amiloride and other pharmacological agents were given into the brain in this study. Results: CA increased ASIC1 in the hippocampus of rats in comparison with control animals. This was associated with the increase in IL-1β, IL-6 and TNF-α together with Caspase-3 and Caspase-9. The administration of amiloride into the lateral ventricle attenuated the upregulation of Caspase-3/Caspase-9 and this further alleviated neurological severity score and brain edema. Inhibition of central IL-6 and TNF-α also decreased ASIC1 in the hippocampus of CA rats. Conclusion: Transient global ischemia induced by CA amplifies ASIC1a in the hippocampus likely via PIC signal. Amiloride administered into the Central Nervous System plays a neuroprotective role in the process of global ischemia. Thus, targeting ASICs (i.e., ASIC1a) is suggested for the treatment and improvement of CA-evoked global cerebral ischemia.

scholarly journals Acute Graft-Versus-Host Disease, Infections, Vascular Events and Drug Toxicities Affecting the Central Nervous System

2021 ◽  
Vol 12 ◽  
Author(s):  
Janaki Manoja Vinnakota ◽  
Robert Zeiser
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Acute Gvhd ◽  
Hematopoietic Cell Transplantation ◽  
Neurological Deficits ◽  
Vascular Events ◽  
Drug Induced ◽  
Curative Therapy ◽  
The Central Nervous System ◽  
Acute Graft

Allogeneic hematopoietic cell transplantation (allo-HCT) is a curative therapy for patients with hematological malignancies. Acute Graft versus host diseases (GVHD) is a major immune mediated side effect of allo-HCT that can affect the central nervous system (CNS) in addition to post-allo-HCT vascular events, drug toxicity or infections. Here we summarize and discuss recent preclinical data on the CNS as a target of acute GVHD and the known mechanisms contributing to neurotoxicity with a focus on microglia and T cells. We also discuss open questions in the field and place the findings made in mouse models in a clinical context. While in mice the neurological deficits can be assessed in a controlled fashion, in patients the etiology of the CNS damage is difficult to attribute to acute GVHD versus infections, vascular events, and drug-induced toxicity. Ultimately, we discuss novel therapies for GVHD of the CNS. Our understanding of the biological mechanisms that lead to neurotoxicity after allo-HCT increased over the last decade. This review provides insights into CNS manifestations of GVHD versus other etiologies of CNS damage in mice and patients.

scholarly journals Cerebellar Neurocysticercosis as Long-Term Complication of Allogeneic Haematopoietic Stem Cell Transplantation from Haploidentical Donor

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Federico Meconi ◽  
Giulia Ciangola ◽  
Benedetta Mariotti ◽  
Raffaella Cerretti ◽  
Laura Cudillo ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Haematopoietic Stem Cell Transplantation ◽  
Taenia Solium ◽  
Haematopoietic Stem Cell ◽  
The Central Nervous System

Neurocysticercosis, an infection of the central nervous system with the larval stage of the cestode Taenia solium, is uncommon in developed countries. We report a case of allogeneic haematopoietic stem cell transplantation from a haploidentical donor complicated, in the long term, by T. solium infection of the central nervous system and successfully treated with empiric antiparasitic therapy with albendazole plus dexamethasone. Revised diagnostic criteria proposed by Del Brutto et al. were used for the definitive diagnosis of cerebellar neurocysticercosis.

scholarly journals Disseminated inflammation of the central nervous system associated with acute hepatitis E: a case report

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jan Rahmig ◽  
Arne Grey ◽  
Marco Berning ◽  
Jochen Schaefer ◽  
Martin Lesser ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Central Nervous System ◽  
Nervous System ◽  
Acute Hepatitis ◽  
Liver Enzymes ◽  
Hepatitis E ◽  
Neurological Deficits ◽  
Off Label ◽  
The Central Nervous System ◽  
Acute Hepatitis E

Abstract Background Hepatitis E infection affects over 20 million people worldwide. Reports of neurological manifestations are largely limited to the peripheral nervous system. We report a middle-aged genotype 3c male patient with acute hepatitis E virus (HEV) infection and severe neurological deficits with evidence of multiple disseminated inflammatory lesions of the central nervous system. Case presentation A 42-year-old male patient presented to our emergency department with musculoskeletal weakness, bladder and bowel retention, blurred vision and ascending hypoesthesia up to the level of T8. Serology showed elevated liver enzymes and positive IgM-titers of hepatitis E. Analysis of cerebrospinal fluid (CSF) showed mild pleocytosis and normal levels of glucose, lactate and protein. HEV-RNA-copies were detected in the CSF and stool. Within 3 days after admission the patient became paraplegic, had complete visual loss and absent pupillary reflexes. MRI showed inflammatory demyelination of the optic nerve sheaths, multiple subcortical brain regions and the spinal cord. Electrophysiology revealed axonal damage of the peroneal nerve on both sides with absent F-waves. Treatment was performed with methylprednisolone, two cycles of plasma exchange (PLEX), one cycle of intravenous immunoglobulins (IVIG) and ribavirin which was used off-label. Liver enzymes normalized after 1 week and serology was negative for HEV-RNA after 3 weeks. Follow-up MRI showed progressive demyelination and new leptomeningeal enhancement at the thoracic spine and cauda equina 4 weeks after admission. Four months later, after rehabilitation was completed, repeated MRI showed gliotic transformation of the spinal cord without signs of an active inflammation. Treatment with rituximab was initiated. The patient remained paraplegic and hypoesthesia had ascended up to T5. Nevertheless, he regained full vision. Conclusions Our case indicates a possible association of acute HEV infection with widespread disseminated central nervous system inflammation. Up to now, no specific drugs have been approved for the treatment of acute HEV infection. We treated our patient off-label with ribavirin and escalated immunomodulatory therapy considering clinical progression and the possibility of an autoimmune response targeting nerve cell structures. While response to treatment was rather limited in our case, detection of HEV in patients with acute neurological deficits might help optimize individual treatment strategies.

scholarly journals Migration of Self-Introduced Acupuncture Needle into the Brainstem

2018 ◽  
Vol 09 (03) ◽  
pp. 434-436
Author(s):  
Shadi El-Wahsh ◽  
Johnny Efendy ◽  
Mark Sheridan
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Conservative Management ◽  
Foreign Bodies ◽  
Neurological Deficits ◽  
Acupuncture Needle ◽  
Surgical Extraction ◽  
The Central Nervous System ◽  
Operative Assessment

ABSTRACTAcupuncture-related injuries to the central nervous system are a rare but well-documented occurrence. This report describes the case of a self-introduced acupuncture needle migrating into the brainstem following an initial failed attempt at surgical extraction. The patient displayed no neurological deficits, and the needle was eventually successfully removed under direct vision intraoperatively. We discuss the role of various imaging modalities in pre- and post-operative assessment of penetrating foreign bodies in the brainstem. We also discuss the options available for the management of such foreign bodies, including possible approaches for operative intervention, and the risks involved with both surgical and conservative management.

scholarly journals A Rare Case of Spontaneous Remission and Relapse of a Primary Central Nervous System Lymphoma

2018 ◽  
Vol 31 (12) ◽  
pp. 777 ◽  
Author(s):  
Rui Ramos ◽  
João Soares Fernandes ◽  
Marta Almeida ◽  
Rui Almeida
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Rare Case ◽  
Central Nervous System Lymphoma ◽  
Brain Biopsy ◽  
B Cell Lymphoma ◽  
Spontaneous Remission ◽  
Neurological Deficits ◽  
Pubmed Search ◽  
The Central Nervous System

Primary central nervous system lymphoma remission after steroid treatment is a well-known phenomenon, but remission without any type of treatment is extremely rare. We present a rare case of spontaneous remission of a diffuse large B-cell lymphoma of the central nervous system as well as its subsequent reappearance in another location. The atypical presentation misled the neurosurgeons and neurologists, delaying diagnosis and treatment. The patient underwent brain biopsy after the relapse and started radiotherapy and chemotherapy with cytarabine + methotrexate + rituximab. As of 32 months after the diagnosis, the patient remained asymptomatic, with no focal neurological deficits and the disease in complete remission. A PubMed search of the literature up to June 2017 regarding spontaneous remission central nervous system lymphoma was also carried out.

scholarly journals Cysticercosis Involving Muscle of Mastication: A Review and Report of Two Cases

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Sarbjeet Singh ◽  
V. Sreenivasan ◽  
Kanika Garg ◽  
Nikhel Dev Wazir ◽  
Jaspal Singh Rajput ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Taenia Solium ◽  
Parasitic Infection ◽  
Primary Site ◽  
Common Disease ◽  
Temporalis Muscle ◽  
Mri Findings ◽  
Larval Stages ◽  
The Central Nervous System

Cysticercosis is a parasitic infection caused by the larval stages of the parasitic cestode,Taenia solium. It is a common disease in developing countries where it is also endemic. The central nervous system (CNS) is the most important primary site of infection and the disease can present with solitary or multiple space occupying lesions. Cases of cysticercosis presenting as isolated muscle mass (pseudotumours) without involvement of the CNS have also been recently described in the literature. We present two cases who presented to us with pain, swelling, and tenderness involving the temporalis muscle along with trismus. Ultrasonography and MRI findings were suggestive of cysticercosis involving the temporalis muscle which resolved after the albendazole therapy.

Clear Cell Tumors of the Central Nervous System: A Case-Based Review

2012 ◽  
Vol 136 (8) ◽  
pp. 915-926 ◽  
Author(s):  
Sandra Camelo-Piragua
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Clear Cell ◽  
Diagnostic Tools ◽  
Tumor Subtypes ◽  
System A ◽  
The Central Nervous System ◽  
Complex Features ◽  
Case Based ◽  
Radiologic Features

Clear cell tumors of the central nervous system (CNS) encompass a variety of tumor subtypes that are challenging to diagnose given their similar morphologic features. Here, I use a case-based approach to review the clinicopathologic and radiologic features to help guide the general pathologist in the diagnosis of clear cell tumors of the CNS. First, the reader is invited to study 6 images of different CNS tumors with clear cell morphology. Then, each case is expanded in light of clinical and radiologic data and includes a histopathologic description of the tumor. A brief discussion follows with up-to-date diagnostic tools. Finally, I propose an immunohistochemical algorithm to navigate through the complex features that characterize clear cell tumors of the CNS. This review aims to provide a comprehensive approach to diagnosing clear cell neoplasms of the CNS based on improved assessment of the clinicopathologic and radiologic features of each entity.

Surgical treatment for fungal infections in the central nervous system

1985 ◽  
Vol 63 (3) ◽  
pp. 371-381 ◽  
Author(s):  
Ronald F. Young ◽  
George Gade ◽  
Verity Grinnell
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Mortality Rate ◽  
Fungal Infection ◽  
Surgical Therapy ◽  
Fungal Infections ◽  
Neurological Deficits ◽  
Morbidity Rate ◽  
Communicating Hydrocephalus ◽  
The Central Nervous System

✓ The hospital records of 78 patients who underwent surgical therapy for fungal infections of the central nervous system (CNS) between 1964 and 1984 are summarized. Nine different fungal types were identified, but Coccidioides immitis and Cryptococcus neoformans accounted for most (67.1%) of the infections. A variety of clinical syndromes were seen, including chronic basal meningitis (45 patients), intracranial mass lesions (12 patients), and communicating hydrocephalus (six patients). Thirteen patients had rhinocerebral forms of fungal infection, and two presented with spinal involvement. Delays in diagnosis were frequent and ranged from 2 months to 11 years. In 31 patients the CNS lesion was the first indication of a fungal infection, and lesion biopsy or cerebrospinal fluid (CSF) examination confirmed the diagnosis. A total of 144 surgical procedures were carried out, including lesion biopsy or excision in 13 patients, primary CSF shunting in 22, and placement of an Ommaya reservoir for administration of intraventricular or intracisternal antifungal agents in 48. All patients received parenteral and, in some cases, intrathecal or oral antifungal chemotherapy in addition to surgical therapy. Overall mortality was 43.6% (34 deaths). With prompt diagnosis and treatment, the mortality rate was 39% whereas, when appropriate treatment was delayed, the mortality rate was 64%. An additional 14 surviving patients (17.9%) exhibited permanent morbidity due to neurological deficits, seizure disorders, or renal toxicity following treatment with amphotericin B. The combined mortality and morbidity rate was 62.8%. Clinical symptoms were resolved completely in 29 patients, although in 10 evidence of disease persisted and chemotherapy was continued. Fungal infections of the CNS are being recognized with increased frequency. It is suggested that a high index of suspicion, aggressive attempts to obtain a diagnosis, and early and vigorous therapy may reduce the unfortunate outcome seen in a relatively high proportion of patients with CNS fungal infections.

scholarly journals Bruns' syndrome and racemose neurocysticercosis: a case report

2012 ◽  
Vol 45 (2) ◽  
pp. 269-271 ◽  
Author(s):  
Roberta Diehl Rodriquez ◽  
Denise Neme da Silva Crestani ◽  
José Otávio Dworzecki Soares ◽  
Paulo Roberto Franceshini ◽  
Ronnie Petersen Alves ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Immune Response ◽  
Nervous System ◽  
Taenia Solium ◽  
Clinical Manifestations ◽  
Head Posture ◽  
Stage Of Development ◽  
Type Size ◽  
The Central Nervous System ◽  
Basal Cisterns

Cysticercosis is an infection caused by the larval stage of the tapeworm Taenia solium. The parasite may infect the central nervous system, causing neurocysticercosis (NCC). The clinical manifestations depend on load, type, size, location, stage of development of the cysticerci, and the host's immune response against the parasite. The racemose variety occurs in the ventricles or basal cisterns and is a malignant form. Mobile ventricular mass can produce episodic hydrocephalus on changing head posture with attacks of headache, vomiting, and vertigo, triggered by abrupt movement of the head, a phenomenon called Bruns' syndrome (BS). We report a patient with racemose NCC and BS.

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