Liquido cefalorraquiano na cisticercose encefalica
Reis, João Baptista dos [UNIFESP]
Bei, Antonio [UNIFESP]
Reis-filho, João B. [UNIFESP]
Nasser, Jayme [UNIFESP]
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Cerebrospinal fluid (CSF) changes in brain cysticercosis have long been known. Its characteristic features are a mild or moderate pleocytosis with eosinophils, a slight or moderate protein increase with an elevated gammaglobulin concentration, and a positive complement fixation test. Unfortunately all these abnormalities are not always present together and difficulties may be encountered in the diagnosis. This paper presents a study based on the experience acquired in the CSF Laboratory of the Neurological Department of Escola Paulista de Medicina (São Paulo, Brasil) after 35 years' work, and 120.000 CSF specimens examined. The material consists of 147 cases of brain cysticercosis confirmed by necropsy, surgery, subcutaneous or intraocular cysticercus, x ray of the skull, and of 509 clinical observation with suggestive CSF changes. It is the purpose of this paper to appreciate the importance of each of the CSF tests and to observe the CSF abnormalities during the course of this disease. The results of the study of the 79 cases verified by necropsy or surgery showed that the characteristic CSF changes that make the diagnosis of brain cysticercosis were observed in 54 per cent of the cases. The eosinophils were present in 82 per cent, protein changes in 78 per cent, complement fixation test in 70 per cent, hypertension in 55 per cent, and decreased sugar content in 27 per cent of the cases. In two cases the CSF was normal. As the eosinophils and the protein abnormalities may be seen in several other diseases, the complement fixation test for cysticercus should be regarded as the most important CSF test in the diagnosis of brain cysticercosis. The successive CSF specimens withdrawn of 40 patientes during the course of this disease have shown that the abnormalities went on for 4 to 18 years observation, suggesting that the parasites were alive. On the contrary, in 11 other cases it was verified the final CSF normalization after 5 to 14 years, suggesting that the parasites were dead. The CSF was normal in 31 out of 42 patients with opaque nodules visible in skull films (calcified cysticercus). in the remaining 11 cases, the characteristic CSF findings were observed in 3, but in 8 cases the only abnormalities were positive complement fixation test or eosinophils. In 14 out of 26 patients with subcutaneous or intraocular cysticercus there were the usual CSF changes but in the other remaining cases the CSF was normal. The absence of treatment for brain cysticercosis is consistent with the persistence of CSF abnormalities in the specimens examined during the course of this disease. This calls for an integrated prophylactic to all Latin-American countries in order to exterminate this serious disease for the well-being of the next generation.Foi feito um estudo do comportamento do líquido cefalorraquiano (LCR) na cisticercose encefálica, com base em 656 observações retiradas de um material constituído por 120.000 exames de pacientes neurológicos e psiquiátricos, reunidas em 35 anos de trabalho. Com base nos casos comprovados por necrópsia ou cirurgia foram descritas as alterações do LCR. O estudo consecutivo de amostras de LCR obtidas em anos sucessivos, durante o decurso da doença, mostrou a persistência das alterações em numerosos casos, mesmo depois de 4 a 18 anos de observação. A reação de fixação de complemento para cisticerco permaneceu positiva durante todos estes anos. Foram também apreciadas as modificações do LCR em casos de cisticercose sub-cutânea e do globo ocular e em casos com cisticercos calcificados no encéfalo.
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