Cerebral cysticercosis
Introduction
Introduction to cerebral cysticercosis Cerebral cysticercosis refers to a disease in which the larvae of swine mites are parasitic in the brain, and the meninges and ventricles cause corresponding neurological dysfunction. It accounts for more than 80% of cysticercosis, and the incidence rate is higher in North China, Northeast China and Northwest China. basic knowledge The proportion of sickness: 0.01% - 0.02% Susceptible people: no specific population Mode of infection: digestive tract spread Complications: epilepsy, headache, coma
Cause
Cause of cerebral cysticercosis
Aphid eggs entering the stomach through various pathways, hatching into cysticercosis in the duodenum, drilling into the intestinal wall through the intestinal venous vein into the systemic circulation and choroid and entering the brain parenchyma, subarachnoid space and ventricular system, causing various damage .
The pathological changes caused by cysticercosis are mainly due to the mechanical stimulation of the worm and the action of toxins. Cysticercus sinus occupies a certain volume in the tissue, which is a space-occupying lesion; at the same time, the local tissue is destroyed, and the tissue damage is also serious in the case of severe infection; the cysticercosis has an oppressive effect on the surrounding tissue, and if the compression of the lumen can cause obstructive changes; The toxin action of Cysticercus can cause significant local tissue reactions and increased blood eosinophils of varying degrees of systemicity and the production of specific antibodies.
Prevention
Cerebral cysticercosis prevention
The most important thing to prevent is the strict implementation of the food management law. It is strictly forbidden to market pork with cysticercosis. In addition, it is also important for the management and treatment of pigs, such as captivity, timely treatment of pig intestinal mites, and slaughter of pigs with cysticercosis. Industrial raw materials, etc.
Complication
Cerebral cysticercosis complications Complications, epilepsy, headache, coma
Cerebral cysticercosis can be associated with epilepsy, and can also be associated with ocular cysticercosis, with varying degrees of visual loss.
1, the most common
(1) Epilepsy, most of which are major episodes.
(2) Psychiatric symptoms: manifestations of apathy, mental decline, loss of timing and orientation, insanity, excitement or arrogance, severe dementia, and inability to take care of themselves.
(3) Increased intracranial pressure: symptoms such as headache, vomiting, and papilledema.
(4) local symptoms: such as hemiparesis, paresthesia and positive pyramidal tract signs.
3. ventricle type (1) increased intracranial pressure: performance of headache, vomiting, papilledema, severe coma.
(2) Localized symptoms: The fourth ventricle cysticercosis may appear to be forced to tilt the head position, and the neck is stiff. When the head rotates, if the cystic worm suddenly blocks the cerebrospinal fluid pathway, it will cause a sharp increase in intracranial pressure and cerebral palsy and death.
Subarachnoid type
(1) Chronic meningitis symptoms: such as headache, vomiting and neck stiffness and other meningeal irritation.
(2) Increased intracranial pressure, due to inflammatory adhesions or cysticercosis obstructing the cerebral cistern, resulting in traffic hydrocephalus, resulting in symptoms of intracranial hypertension.
(3) Cranial nerve damage, manifested by vision loss, visual field defects, facial paralysis, difficulty swallowing, hoarseness and other symptoms.
Symptom
Symptoms of cerebral cysticercosis common symptoms headache and vomiting papillary edema meningeal irritation sputum subcutaneous nodular ataxia
First, medical history and symptoms:
There is often a history of eating rice pork or contaminated food by mites. According to the number of cystic worms invading the nerve tissue, there are inflammatory reactions and poisoning irritations, which can be divided into the following types according to clinical manifestations:
1. Meningoencephalitis type: more common, often caused by a large number of infections, resulting in diffuse cerebral edema, reactive inflammation, clinical manifestations of mental symptoms.
2. Epilepsy type: cysticercosis is located in the cortical motor area, and epileptic seizures are prominent symptoms, and the forms may be large seizures, small episodes, and psychomotor seizures.
3. Intracranial pressure type: cysticercosis parasitic in the ventricular system affects cerebrospinal fluid circulation, clinical manifestations of headache, vomiting, blurred vision and other high intracranial pressure symptoms.
Second, physical examination found:
Depending on the clinical type, there may be different clinical signs in the physical examination.
1. Subcutaneous nodules, most patients can touch 0.5-1.5cm solid texture, the skin can move freely, no tender or round or oval subcutaneous nodules, biopsy can confirm the diagnosis.
2. Focal signs, cysticercosis in the brain parenchyma due to the surrounding inflammatory reaction, there may be corresponding signs of focal brain dysfunction, such as monoterpene, hemiplegia, ataxia, positive pyramidal tract sign, meningeal irritation positive, etc. , high intracranial pressure type visible papilledema, decreased vision.
Third, auxiliary inspection:
1. Blood and cerebrospinal fluid examination: eosinophilia.
2. The cysticercosis complement test is positive.
3. Fecal examination revealed aphid eggs or segments.
4. Lumbar puncture pressure can be increased, cerebrospinal fluid cytology, protein can be increased.
5. Skull CT or MRI examination can be clearly diagnosed by multiple scattered lesions in the skull.
Examine
Examination of cerebral cysticercosis
1. Skull CT or MRI examination can be clearly diagnosed by multiple scattered lesions in the skull. 1. The history is mostly caused by swallowing pig worm eggs, a few from self-infection, pay attention to whether there is a history of unclean diet, stool or vomit, have you seen mites, with or without headache, nausea, vomiting, blurred vision and repeated Seizures. A period of remission in which the disease can sometimes be good or bad.
2. Physical examination: pay attention to subcutaneous nodules, biopsy confirmed cysticercosis, vision and fundus changes, or meningeal irritation.
3. Laboratory examination: blood eosinophilia, cerebrospinal fluid examination protein increased, the number of cells increased, sometimes eosinophils can be seen, feces can be detected in the feces or eggs, serum, cerebrospinal fluid cysticercosis antibody complement binding test and The intradermal test was positive and the enzyme-linked adsorption test was positive.
4. Head X-ray film shows signs of increased intracranial pressure, occasionally cystic calcification.
5. Cerebral angiography, ventriculography can show lesions, cysticercosis can be seen in the cysticercosis, or the ventricular system above the obstruction site is enlarged.
6. Head CT scan or magnetic resonance imaging, single or multiple clear cystic lesion signs with calcification and contrast enhancement.
7. The ventricle was examined by pathology and confirmed by pathology.
Diagnosis
Diagnosis and identification of cerebral cysticercosis
diagnosis
1 history of locusts and history of rice and pork;
2 has neurological symptoms and signs;
3 biopsy and pathology confirmed cystic nodules;
4 cysticercosis immunological test positive;
5 cerebrospinal fluid pressure increased, the number of eosinophils increased;
6 skull CT and MRI scans were consistent with cysticercosis;
7 EEG has abnormalities.
It is not difficult to distinguish from meningitis caused by other diseases, intracranial hypertension and primary epilepsy.
