Cysticercosis, also known as porcine cysticercosis, is a disease caused by the larvae (cysticercus) of the pork tapeworm parasitizing the human body, with cerebral cysticercosis being the most serious. 50% to 70% of patients with cysticercosis may have central nervous system involvement. This disease is one of the more common parasitic diseases in China. It has a high incidence in northeast, north, northwest and southwest China.
[Etiology]
Cerebral cysticercosis is a parasitic disease of the brain caused mostly by the larvae of the pig tapeworm (Cysticercus bovis), which is the most common of the domestic brain parasitic diseases. Its incidence is quite high, accounting for more than 80% of cysticercosis patients. It is mostly found in northwest, north, northeast, and northeastern China. It is often due to poor personal hygiene, not washing hands before meals after defecation, eating food or drinking water contaminated by the eggs of pork tapeworm excreted in the stool by oneself or other pork tapeworm patients;
Or, when a patient with pork tapeworm disease vomits, the adult worm segments shed in the intestine enter the stomach with the retrograde peristaltic movement of the stomach and a large number of eggs are released after the segments are digested. The larvae of the eggs hatch in the intestine and burrow into the blood vessels and lymphatic vessels of the intestinal wall, and are carried through the blood circulation to develop into cysts in various tissues throughout the body. Cysticerci are most commonly found in subcutaneous tissues, muscles, oral mucosa, eyes and brain, but rarely in the spinal cord. Cysticerci are mostly distributed in the gray matter or the junction of gray and white matter in the brain, followed by the ventricles and the vicinity of the ventricles, and the base of the brain and the meninges.
Inflammatory and degenerative changes can be seen around the cysts in the gray matter of the brain, leading to corresponding functional impairment of the brain. If the cysticerci are located in or near the 3rd and 4th ventricles or cerebral aqueducts, they will obstruct the cerebrospinal fluid circulation and cause hydrocephalus or increased intracranial pressure; if the cysticerci are located in the meninges, they may cause meningitis. The cysticerci may be absorbed or calcified after death.
[Clinical manifestations]
The clinical manifestations are closely related to the location, number, biological status of the cysticerci and the nature and intensity of damage to their surrounding brain tissue. When the larvae enter the bloodstream in large numbers, symptoms of allergic reactions such as fever, urticaria and general malaise may occur; in children, headache, vomiting and convulsions are more common, but the duration is generally shorter than in adults. Cysticercus can cause vision loss or blindness when it grows in the eye. Subcutaneous growth (subcutaneous cyst nodules can be felt in about 80-100% of patients) and in the muscles may occasionally cause pain or numbness on the body surface innervated by the nerve due to compression of nearby sensory nerves by the cysts.
Patients (or family members) with concomitant intestinal tapeworm disease may have a history of spaghetti-like tapeworm nodules.
Brain symptoms are varied and may be more or less frequent, or may even be absent (due to low numbers of cestodes or growth in functional quiet areas of the brain). The symptoms are described below according to their frequency.
I. Seizures The most common. They are seen in almost all patients, such as generalized tonic-clonic seizures (grand mal seizures), aphasic seizures (petit mal seizures), simple partial seizures (Jaxon’s epilepsy, limited sensory or motor seizures) and complex partial seizures (psychomotor epilepsy). The same patient can have different types of seizures at different times, but generally grand mal seizures are still the majority. The seizures are caused by the stimulation of cysticercus in different parts of the cerebral cortex.
Increased intracranial pressure is more common (about 23%). The main symptoms include headache, vomiting, loss of vision and optic papillary edema. It is caused by the obstruction of the interventricular foramen of the lateral ventricles, cerebral aqueduct, 3rd to 4th ventricles or the basal pool of the brain by cysticerci, or the restriction of cerebral arachnoid adhesions caused by the basal cysticerci, which affects the circulation of cerebrospinal fluid. If the cysticercus is located in the ventricular system, clinical symptoms such as severe vertigo, headache, nausea, vomiting, respiratory and circulatory disorders, and even coma may occur suddenly when the head position is changed (Brun syndrome). It is caused by acute obstruction of cerebrospinal fluid circulation caused by cysticerci, acute increase of intracranial pressure and stimulation of vagal nucleus.
Mental abnormalities are more common (about 29%). It may be related to severe and extensive organic damage to the brain tissue, especially the cerebral cortex.
Meningitis at the base of the brain is rare (about 5-6%). It may manifest as fever, headache, vomiting, meningeal irritation signs and multiple cranial nerve palsy. It is caused by cysticerci stimulating the meninges and compressing the cranial nerves, or by cysticerci causing cerebral arachnoid adhesions and pulling the cranial nerves.
Sensory and motor disorders such as hemiparesis (damage to the anterior central gyrus or pyramidal tract), hemianopia (damage to the optic tract or optic radiation), aphasia (damage to the corresponding speech centers in the main cerebral hemisphere cortex), and cerebellar and extrapyramidal symptoms are all clinical manifestations of limited brain damage caused by cysticercus.
[Ancillary tests]
In the stool of patients with concomitant intestinal tapeworm disease, adult tapeworm segments can often be found, but the likelihood of finding eggs is generally low. Cerebrospinal fluid may have elevated eosinophil count, protein content and pressure.
Immunological examination Intradermal tests, as well as cerebrospinal fluid and serum immune antibodies and antigens may be positive.
Intracranial plain films and soft tissue fluoroscopy (or photographs) of the extremities may show calcified spots. Cranial CT and magnetic resonance examination are helpful in the identification of cysticercosis, as well as in the diagnosis of cerebral arachnoid adhesions, cerebral cortical atrophy, and ventricular enlargement and obstruction.
[Diagnosis]
History of fecal tapeworm, subcutaneous cysticercus nodules, radiographic findings of cysticercus and its calcified shadows in the head and extremities (with a higher positive rate in the calf area), elevated cerebrospinal fluid eosinophil counts, positive cysticercus intradermal tests or/and cerebrospinal fluid immune antibody and antigen tests, and corresponding brain symptoms and signs are important diagnostic bases for this disease. If the biopsy of subcutaneous nodules or cranial CT or magnetic resonance examination confirms cysticercosis, the diagnosis is even more definite. However, it should be distinguished from other causes of epilepsy, meningitis and intracranial occupying lesions.
[Treatment]
If intestinal tapeworm parasites are diagnosed (including family members), tapeworm treatment should be carried out as follows.
1, betel nut, pumpkin seeds betel nut on the tapeworm’s head and anterior segment, pumpkin seeds on its middle and posterior segment has a paralyzing effect, so the combination of the two can improve the efficacy (up to 90%). The method is 60 ~ 90 grams of pumpkin seeds slightly fried, peeled to take kernel powder, once in the morning on an empty stomach, two hours later followed by a decoction of betel nut ( 60 ~ 90 grams of betel nut cut into fine slices, add 500 ml of water decoction to 250 ml or so filtered, the filtrate is a dose of adults), and then half an hour later add 50% magnesium sulfate 60 ml, generally seen in 3 hours after the discharge of worms.
2, tapeworm adults take 2 times orally on an empty stomach, each time 1 gram (one hour interval). 2 hours later, then take 50% magnesium sulfate 60 ml. After taking occasional dizziness, chest tightness and stomach discomfort, more soon after the self disappeared.
3.Anlast 200mg for adults, 100mg for children orally, 2 times / day for a total of 3 days.
Second, treatment of brain cysts requires hospitalization.
Prothiimidazole or praziquantel (both have the effect of tapeworm), the daily dose is 15-20mg/kg body weight, the former is taken twice after meals for 10 days; the latter is taken 3 times after meals for 6 days as a course of treatment, and then repeat a course of treatment after 20 days, and then repeat a course of treatment after 3-6 months and 12 months respectively if necessary, in order to cure completely.
The former has lighter toxic side effects; the latter can cause toxic side effects such as increased intracranial pressure, so it is not used too much now. If the patient cannot tolerate the above dose, the dose can be reduced to 1/2, 1/3 or 1/4 of the dose, and if necessary, appropriate amount of prednisone and diuretic dehydration agents can be added to reduce the, at the same time should also strengthen its symptomatic treatment. It is contraindicated in pregnant women, and should be used with caution in cases of severe liver, kidney and heart insufficiency and active gastric ulcers.
Surgery For severe and frequent seizures with limited seizures, craniotomy can be considered to remove the cysticercus if systematic antiepileptic drug treatment is ineffective. If the cysticercus is located in the ventricles of the brain and causes serious increase of intracranial pressure, craniotomy can be performed to remove the cysticercus or perform other decompression surgery.
Fourth, symptomatic treatment such as strengthening anti-seizure (seizure reduction), anti-basal meningitis, anti-psychiatric symptoms and lowering intracranial pressure.