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Background: The conventional clinical case definition of cerebral malaria (CM) is imprecise but specificity is improved by a definitive clinical feature such as retinopathy or confirming sequestration of parasites in a post-mortem examination of the brain. A full autopsy is often not possible, since it is costly and may encounter resistance of the deceased's family., Methods: We have assessed the use of a cytological smear of brain tissue, obtained post-mortem by supraorbital sampling, for the purpose of quantifying cerebral sequestration in children with fatal malaria in Blantyre, Malawi. We have compared this method to histological quantification of parasites at autopsy., Results: The number of parasites present on cytological smears correlated with the proportion of vessels parasitized as assessed by histology of fixed and stained brain tissue. Use of cytological results in addition to the standard clinical case definition increases the specificity of the clinical case definition alone from 48.3% to 100% with a minimal change in sensitivity., Conclusions: Post-mortem supraorbital sampling of brain tissue improves the specificity of the diagnosis of fatal cerebral malaria and provides accurate quantitative estimates of cerebral sequestration. This tool can be of great value in clinical, pathogenetic, and epidemiological research studies on cerebral malaria.

Cerebral alveolar echinococcosis (AE) is a rare and difficult-to-treat zoonosis caused by Echinococcus multilocularis. A 29-year-old immigrant from Siberia with a past history of hepatic AE, presented with acute onset of grand mal seizures, weakness of the left leg, and cephalgia. Magnetic resonance imaging of the brain revealed inoperable right-sided infiltrative lesions, suggesting cerebral AE. Despite anthelmintic treatment only slow improvement occurred., (© 2012 International Society of Travel Medicine.)

Infection with pork tapeworm, or Taenia solium, affects approximately 50 million people worldwide. The most important and potentially devastating form of the infestation, neurocysticercosis, occurs when the parasite invades the central nervous system. There has been a significant increase in the number of cases in the United States due to immigration from endemic areas. This case study of a pregnant woman in the 35th week of gestation exemplifies the serious consequences of this infection in pregnancy, and discusses an evidence-based approach to the diagnosis, treatment and eradication of this preventable disease., (© 2012 AWHONN.)

Neurocysticercosis is a serious zoonotic diseas, encountered worldwide, caused by the larval stage of Taenia solium. Due to the difficulties facing scientists to study the biological, histological and immunological effects of these larvae on the human brain, other cestodes with more or less similar larvae (Taenia crassiceps) were used. In brain infected mice, Th1 predominant cytokines were significantly detected.

Human African trypanosomosis, caused by Trypanosoma brucei gambiense, is a chronic disease, although various clinical patterns have been observed, from asymptomatic to acute forms. Since 2001 in Angola, 80% of patients have been found to be in the meningoencephalitic stage of the disease. The existence of an acute form of the disease caused by virulent strains of trypanosomes was suspected. To test this hypothesis, four sensitive and polymorphic microsatellite markers were used to characterize the trypanosome DNA extracted from the blood and cerebrospinal fluid of 100 patients in the meningoencephalitic stage. Twenty-three patients were found with mixed T. b. gambiense genotypes in the blood and/or cerebrospinal fluid. The absence of association between the number of infecting genotypes, the presence of neurological signs and white blood cell counts in the cerebrospinal fluid, seems to indicate, at least in the context of the present study, the absence of virulent strains. However, out of five patients who died from encephalopathy syndrome during treatment with eflornithine, three harbored multiple infections., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Neurocysticercosis (NCC), a helminth infection of the brain, is a major cause of seizures. The mediators responsible for seizures in NCC are unknown, and their management remains controversial. Substance P (SP) is a neuropeptide produced by neurons, endothelial cells and immunocytes. The current studies examined the hypothesis that SP mediates seizures in NCC. We demonstrated by immunostaining that 5 of 5 brain biopsies from NCC patients contained substance P (SP)-positive (+) cells adjacent to but not distant from degenerating worms; no SP+ cells were detected in uninfected brains. In a rodent model of NCC, seizures were induced after intrahippocampal injection of SP alone or after injection of extracts of cysticercosis granuloma obtained from infected wild type (WT), but not from infected SP precursor-deficient mice. Seizure activity correlated with SP levels within WT granuloma extracts and was prevented by intrahippocampal pre-injection of SP receptor antagonist. Furthermore, extracts of granulomas from WT mice caused seizures when injected into the hippocampus of WT mice, but not when injected into SP receptor (NK1R) deficient mice. These findings indicate that SP causes seizures in NCC, and, suggests that seizures in NCC in humans may be prevented and/or treated with SP-receptor antagonists.

Echinococcus multilocularis (EM) is caused by the larval stage of the tapeworm. The main endemic regions for human alveolar echinococcosis are Central Europe, Russia, Turkey, Japan, China, Eastern France, North America. EM is an endemic disease in Turkey and especially common in the eastern Anatolia Region as seen in our case. The liver is the primary focus of the disease, cerebral localization is rare. Cerebral hydatid disease is approximately 5% of alveolar hydatid cases and generally considered to be fatal. Surgical treatment should be considered whenever possible. We present a case of cerebral alveolar hydatid disease that was thought to be cerebral metastasis.

Background: Even when radiological images are considered pathognomic for intracranial hydatid cysts, subtle image characteristics are evident depending upon the status/types of hydatid cysts. These imaging features, if finely scrutinized, may help to modify conventional surgical techniques of cyst excision., Methods: From January 2006 to December 2011, nine patients (male:female 7:2, age range 4-44 years, median 7 years) harbouring intracranial hydatid cysts were managed at our centre. In addition to CT scans, all patients underwent plain and contrast-enhanced MRI scans. Based on these radiological findings, the types of hydatid cysts were characterized into simple or complicated (infected) cysts. Complicated cysts were further differentiated into ruptured or intact subtypes based on imaging features. Surgical procedures including the Dowling water dissection technique, in addition to head rotation, were performed for removing these cysts intact., Results: Children (n = 4) aged 6 years or less presented with increasing head size as the only complaint, while the rest of the patients (n = 5) had symptoms of raised intracranial pressure. MRI features of hypo-intensity on T1-weighted images, hyper-intensity on T2-weighted images, and non-contrast-enhancing cysts were noted for all simple cysts (n = 7), while iso- to mixed intensity on T1-weighted images and hyper-intensity on T2-weighted images with contrast-enhancing pericyst correctly diagnosed all complicated (infected) hydatid cysts (n = 2). One of these complicated cysts had spilled the infected contents outside the cyst wall, but within the confines of the cerebral parenchyma (pericyst). Such a case of contained spontaneously ruptured complicated hydatid cyst is described for the first time. At a median follow-up of 18 months, all patients remain free from cyst recurrence., Conclusion: Subtle changes in radiological features of CNS hydatid cysts should be appreciated so as to diagnose the type of cyst correctly. The surgical strategy should be tailored according to the type of cyst for favourable outcome.

Hydatid cyst disease (Echinococcosis) is a parasitic illness that is rarely located in the brain. Primary cerebral hydatid cyst disease is rarely seen. We report here rare two cases presenting with sixth cranial nerve palsy with increased intracranial pressure syndrome due to primary cerebral hydatid cyst. A 5-year-old female and a 13-year-old boy complained of headache, strabismus, nausea, and vomiting. Neurological examination revealed sixth nerve palsy and papilloedema. The diagnosis was cerebral hydatid cyst disease and was confirmed with radiological and pathological investigations. Both cases were operated on. The cysts were removed without rupture, and therapy was completed with albendazole for a period of six months. They were symptom-free during the follow-up period. In conclusion, cerebral hydatid cyst disease should be kept in mind in the differential diagnosis of increased intracranial pressure syndrome.

Introduction: Neurocysticercosis (NCC) is considered to be the most common cause of acquired epilepsy worldwide. Formerly restricted to palliative measures, therapy for NCC has advanced with the advent of two drugs that are considered to be effective: praziquantel (PZQ) and albendazole (ALB)., Areas Covered: All available articles regarding research related to the treatment of NCC were searched. Relevant articles were then reviewed and used as sources of information for this review., Expert Opinion: Anticysticercal therapy has been marked by intense controversy. Recent descriptions of spontaneous resolution of parenchymal cysticercosis with benign evolution, risks of complications and reports of no long-term benefits have reinforced the debate over the usefulness and safety of anticysticercal therapy. High interindividual variability and complex pharmacological interactions will require the close monitoring of plasma concentrations of ALB and PZQ metabolites in future trials. Given the relative scarcity of clinical trials, more comparative interventional studies - especially randomized controlled trials in long-term clinical evolution - are required to clarify the controversy over the validity of parasitic therapy in patients with NCC.

Neurocysticercosis is the most common parasitic infection of the central nervous system. It is a major cause of seizures in developing countries, especially in the Indian subcontinent and most of Asia, Latin America and Africa. It is increasing in prevalence in Muslim countries, especially in the Gulf region reflecting the demographics of these countries which rely heavily on labourers from highly endemic areas. Infections among Muslims in non-endemic regions are increasing. We describe one prospective case report of a Qatari male who presented with seizures and was found to have neurocysticercosis, and three retrospective cases of this infection among Qatari Muslims, who were admitted to a tertiary care hospital over the past 10 years., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

A total of 75 sheep and goats from apparently healthy and from clinically affected flocks were examined for Coenurus cerebralis cysts from different localities in Egypt. Of 25 animals examined from clinically diseased sheep and goats, 25 (100%) revealed the presence of infestation with one to four coenuri in the brain. The sites of predilection were the left hemisphere (48%), followed by the right hemisphere (40%) and the cerebellum (12%). There was no apparent effect of the age of sheep and goats on susceptibility to infestation with C. cerebralis. Another 50 animals from apparently healthy sheep and goat herds presented no C. cerebralis cysts. The cysts from infested sheep could infest newborn puppies experimentally, with a prepatent period of 60 days post infestation. A total of 15 immature worms that were recovered from one puppy did not reach patency until 105 days post infestation with C. cerebralis cyst scolices. Pathological changes in C. cerebralis-infested sheep brain revealed parasitic elements, demyelinated nerve tracts, hyperaemic blood vessels with round cell infiltration, encephalomalacia with round cell infiltration and palisading macrophages and giant cells, as well as focal replacement of the brain parenchyma with caseated and calcified materials. The morphological characteristics of both the larval stage from sheep and goats and adult worms of Taenia multiceps from experimentally infested dogs are described. The results conclude that C. cerebralis is one of the principal causes of nervous manifestations of coenurosis in clinically diseased sheep and goats in Egypt.

The purpose of this paper was to investigate the psychological obstacles and personalities of 86 patients with cerebral cysticercosis, so as to perform necessary nursing for the patients and improve the nursing techniques.

The authors present a case of intracranial hydatid cyst presented with severe headache, nausea and vomiting. Radiological investigations, including CT scan and MRI revealed a solitary cyst in the right temporal lobe, paraventricular area. Total excision of the cyst was done. The features of this rare disease are retrospectively analysed in this presentation and the literature is reviewed.

The authors report a rare case of multiple echinococcosis (brain, heart and kidneys). Neuronavigation, intraoperative ultrasound scanning have allowed to plan exact and non-traumatic access to the cysts. Microsurgical technique and intraoperative neurophysiological monitoring provided removal of seven cysts without their rupture from the left parietooccipital and right parietal area with good postoperative functional result. Serologic analysis of antibodies with antigens of echinococci and histological research confirmed the diagnosis of cystic echinococcosis.

Infectious and inflammatory processes of the intracranial compartment often result in acute clinical presentations. The possible causes are legion. Clues to the diagnosis involve clinical presentation, laboratory analysis, and neuroimaging. This article reviews some of the salient factors in understanding intracranial infection/ inflammation, including pathophysiology and neuroimaging protocols/findings, and provides some examples and a few "pearls and pitfalls.", (Copyright © 2011 Elsevier Inc. All rights reserved.)

We present a 26-year-old patient who did farming related work had an asymptomatic intracranial hydatid cyst. A calcified intracranial cystic mass was found on radiological investigations and the patient underwent surgery. The mass was totally excised. The histopathology result reported a hydatid cyst. There were no postoperative complications. Calcification is quite rare in cerebral hydatid cyst. The computed tomography and magnetic resonance imaging provide information that is especially useful for preoperative diagnosis. Observing membrane detachment and daughter cysts during these investigations is pathognomonic. The presence of calcification in the cyst wall and intracystic membranes indicated hydatid cyst.

Coenurosis, a rare zoonotic disease caused by the larval form of Taenia multiceps (bladderworm) is common in sheep rearing countries, but human infections are rare. Central nervous system involvement produces large giant sized cysts that radiologically closely mimic hydatid cysts. Most human infections resulting in cerebral coenuri have been reported from Europe and Africa. We report two cases of cerebral coenurosis from India, the first in a 55-year-old male presenting with a large cystic lesion in the right parietooccipital region and the second occurring in a 36-year-old male involving the left temporal trigonal region, that radiologically closely mimicked hydatid cyst. Histopathologic examination revealed characteristic features of coenuri with multiple protoscolices invaginating into a large cyst lined by outer cuticular layer. Awareness of this rare parasitic infestation is important to discriminate from the more common hydatid and giant cysticercal cysts.

Objective: To explore the approach of operation plus chemotherapy in the treatment and diagnosis of human complicated alveolar echinococcosis (AE) in multi-organs (liver, lung and brain)., Methods: The clinical data for 17 cases of alveolar echinococcosis were reviewed by a follow-up of 1 - 7 years between 2000 and 2009 at our hospital., Results: Among 17 cases, 8 cases achieved an excellent effect after taking liposomal albendazole, 3 cases received radical hepatectomy and 1 case pneumonectomy with a better effect, 1 case of palliative liver transplantation had lung metastasis and stayed on a long-term therapy of liposomal albendazole. Another case of liver transplantation received a long-term postoperative chemotherapy. And the metastases of lung and brain were found. Three operative cases suffered serious complications in liver and brain and received a long-term chemotherapy. One of them died of serious brain complications after a 6-month follow-up. And one advanced AE patient died at home due to a refusal of any further treatment. Since more than two organs are involved by AE lesion of alveolar echinococcosis, it was rather difficult to diagnose and cure AE radically by complicated surgery. Thus the life quality and long-term survival of patients were seriously endangered., Conclusion: Based on surgical approaches for serious complications and a comprehensive medical therapy, the multi-organ AE patients may have a prolonged survival and an improved clinical outcome.

Visceral leishmaniasis is a severe and potentially fatal vector-borne disease. The most typical symptoms are fever, hepatosplenomegaly, weight loss, bleeding and bacterial infections. Neurological changes are rarely reported. This paper describes a child who presented with neurological signs as the first symptoms of leishmaniasis; tone was diminished and tremors in the extremities were observed. A diagnosis of visceral leishmaniasis was confirmed by parasite detection in the bone marrow. Symptoms were reversed by specific treatment. The nature of a possible mechanism of neurological involvement in visceral leishmaniasis remains unexplained.

A retrospective study was carried out to analyze 6 cases of cerebral sparganosis mansoni in Huashan Hospital from August 2005 to August 2009. The epidemiological features, clinical characteristics, therapeutic approaches and outcome of this disease were investigated. Among the patients, 4 cases had a history of eating raw frogs or snakes. 5 showed eosinophilia in peripheral blood, all with positive anti-Sparganum mansoni antibody in serum and cerebrospinal fluid. Cerebral MRI showed placeholder in all patients. Diagnosis was confirmed by pathological examination of operation and species identification. All patients were cured by operation removal and praziquantel treatment.

Cerebral malaria is the most severe neurological complication of infection with Plasmodium falciparum. With >575,000 cases annually, children in sub-Saharan Africa are the most affected. Surviving patients have an increased risk of neurological and cognitive deficits, behavioral difficulties, and epilepsy making cerebral malaria a leading cause of childhood neurodisability in the region. The pathogenesis of neurocognitive sequelae is poorly understood: coma develops through multiple mechanisms and there may be several mechanisms of brain injury. It is unclear how an intravascular parasite causes such brain injury. Understanding these mechanisms is important to develop appropriate neuroprotective interventions. This article examines possible mechanisms of brain injury in cerebral malaria, relating this to the pathogenesis of the disease, and explores prospects for improved neurocognitive outcome.

Neurocysticercosis is endemic in India, cerebral and ocular manifestations being common. A 32 yr old man on treatment with Albendazole for cerebral neurocysticercosis for 10 days presented with 3 days of painful uniocular blindness. He had only light perception in the left eye, left pupil was non-reactive to light and left disc was edematous. B-scan of eye revealed retinal detachment due to sub retinal cyst and CT brain showed multiple parenchymal cysticerci. The natural history of ocular neurocysticercosis or enhanced sub-retinal inflammation due to Albendazole therapy could have resulted in the retinal detachment in this case.

Objective: To identify the main causes of confirmed malaria deaths and assess the validity and the relevance of use of the MDIF in determining areas for improvement of care., Design: A cross sectional study., Setting: United Bulawayo Hospitals, a tertiary hospital in Zimbabwe., Subjects: Patients whose cause of death was malaria using MIDF., Results: Of 470 confirmed cases admitted in UBH during the study period, 53 (11.2%) died and were included in the study. Most deaths occurred in the over 15 years age group (88.6%) with only 3 deaths each in the other groups. All patients were referred or admitted to UBH with complicated and severe malaria; 39(74 %) had more than one complication such as CM and acute renal failure (ARP). Most patients came from or had visited a rural area and did not implement basic prophylactic and therapeutic measures put in place by the NMCP such as early self-medication. Three pregnant women aborted. Guidelines regarding investigations and treatment were not strictly adhered to. Delay in seeking treatment and in referring was generally observed at all levels of the health system. Cases of malaria deaths were found in the city in people who had not travelled to rural area. The MDIF was used in one case only., Conclusion: Malaria mortality accounted for 11 % of confirmed cases. Main causes of death were CM and ARP Parameters contained in the MDIF were those utilised by most authors who have investigated malaria mortality in Africa and there was a similarity in the observations. In view of the information it could provide if properly used, the MDIF is a valid tool for collecting data that the NMCP needs in order to rationalise its strategies at UBH and in other health facilities. Its use should be generalised and compulsory.

We describe the distribution and abundance of the brain-encysting trematode Euhaplorchis californiensis and its second intermediate host, the California killifish (Fundulus parvipinnis), in 3 estuaries in southern California and Baja California. We quantified the density of fish and metacercariae at 13-14 sites per estuary and dissected 375 killifish. Density (numbers and biomass) was examined at 3 spatial scales, i.e., small replicate sites, habitats, and entire estuaries. At those same scales, factors that might influence metacercaria prevalence, abundance, and aggregation in host individuals and populations were also examined. Metacercaria prevalence was 94-100% among the estuaries. Most fish were infected with 100s to 1,000s of E. californiensis metacercariae, with mean abundance generally increasing with host size. Although body condition of fish did not vary among sites or estuaries, the abundance of metacercariae varied significantly among sites, habitats, estuaries, and substantially with host size and gender. Metacercariae were modestly aggregated in killifish (k > 1), with aggregation decreasing in larger hosts. Across the 3 estuaries, the total populations of killifish ranged from 9,000-12,000 individuals/ha and from 7-43 kg/ha. The component populations of E. californiensis metacercariae ranged from 78-200 million individuals/ha and from 0.1-0.3 kg/ha. Biomass of E. californiensis metacercariae constituted 0.5-1.7% of the killifish biomass in the estuaries. Our findings, in conjunction with previously documented effects of E. californiensis, suggest a strong influence of this parasite on the size, distribution, biomass, and abundance of its killifish host.

Cerebral toxoplasmosis remains one of the most common focal brain lesions in patients with acquired immune deficiency syndrome (AIDS). Diagnosis is a challenge because on cranial imaging it closely mimics central nervous system lymphoma, primary and metastatic central nervous system (CNS) tumors, or other intracranial infections like tuberculoma or abscesses. A magnetic resonance imaging (MRI) feature on postcontrast T1-weighted sequences considered pathognomonic of toxoplasmosis is the "eccentric target sign." The pathological correlate of this imaging sign has been speculative. Herein we correlate the underlying histopathology to the MR feature of eccentric target sign in a patient with autopsy-proven HIV/AIDS-related cerebral toxoplasmosis. The central enhancing core of the target seen on MRI was produced by a leash of inflamed vessels extending down the length of the sulcus that was surrounded by concentric zones of necrosis and a wall composed of histiocytes and proliferating blood vessels, with impaired permeability producing the peripheral enhancing rim.

Echinococcosis is a potentially fatal parasitic disease that can affect many animals and humans. The disease results from infection by tapeworm larvae of the genus Echinococcus--notably, E. granulosus, E. multilocularis, E. vogeli andE. oligarthrus. Cyst hydatid disease is usually seen in adults, and mainly affects liver and/or lungs (90%). Cerebral involvement is very rare (1-3%), and more common in children. Therapy consists of medical treatment and surgical intervention if it is possible. The authors report the case of a 55-year-old male patient with multiple intracranial hydatid cysts, who was successfully treated with albendazole (10 mg/kg/day) alone without any surgical intervention.

Presence of Neospora caninum DNA was detected in the brain and spinal cord of an adult Merino sheep suspected of dying with acute non-suppurative meningoencephalitis and mild to moderate non-suppurative myelitis. The most severe neurological lesions were found in the midbrain at the rostral coliculi with moderate to severe multifocal vasculitis and gliosis. As this was the first known occurrence of cerebral disease in sheep in Australia caused by N. caninum, we surveyed sera from five sheep properties in New South Wales (NSW) to obtain information on the likely prevalence of N. caninum infection in NSW sheep flocks. Serology using a commercial indirect enzyme-linked immunosorbent assay (ELISA) revealed no N. caninum antibody-positive sheep (n=184). However an observed prevalence for N. caninum antibodies using a commercially available competitive ELISA was 2.2% (5/232). We conclude that although the diagnosis of fatal ovine cerebral neosporosis is of importance to our surveillance program for transmissible spongiform encephalopathy (TSE) exclusion, sheep in NSW are not commonly infected with N. caninum and this species likely plays only a minor role in the life cycle of this parasite in Australia., ((c) 2010 Elsevier B.V. All rights reserved.)

Hydatid cyst disease is a parasitic illness that is rarely located in the brain. We present a case of a 26-year-old female who complained of headache, nausea, and vomiting. The diagnosis was intracranial hydatid cyst disease and was confirmed with radiological and serological tests. Neurological examination revealed papilloedema and left-sided pyramidal signs. She was operated on using the Dowling-Orlando technique. The cyst was removed without rupture, and therapy was completed with albendazole for a period of four weeks. In this article, we discuss the application of the Dowling-Orlando technique, microsurgery, the Valsalva manoeuvre and the positioning of the patient such that gravity could facilitate surgical removal of a giant cerebral hydatid cyst.

Objective: Only eight cases of cerebral myiasis in humans have been reported worldwide and only one in the United States. Presented here is a case of cerebral myiasis in the setting of head trauma in suburban Los Angeles., Methods: The article includes chart review and description of a clinical case presentation., Results: A 42-year-old HIV-positive man was found in a ditch after 2 weeks, the victim of apparent assault. He had multiple facial fractures along with open depressed bifrontal sinus fractures with necrotic bone, eroded dura, exposed cortex, and extensive maggot infestation of the left frontal lobe. The patient was taken urgently to the operating room, where the maggots where evacuated by irrigation and suction. Debridement of necrotic bone, dura, and brain was performed, the frontal sinuses were exenterated, and skull defects plated with titanium mesh. Intraoperative cultures revealed a polymicrobial meningitis/encephalitis, which was treated postoperatively with antibiotics. The patient's neurologic exam stabilized and the patient was transferred to a rehabilitation facility for further care, ultimately achieving functionality and holding a job., Conclusion: This is the first published case of cerebral myiasis secondary to trauma, and to our knowledge, the first documented long-term survivor of extensive cerebral myiasis. Wide debridement to normal brain followed by 6 weeks of broad-spectrum antibiotic treatment is effective in managing this condition. A well-functioning outcome can be expected with prompt recognition and treatment of the disease. Larval infestation may have a protective effect against bacterial infection and may allow for greater tolerance of treatment delay., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Background: Neurocysticercosis is an infection of the brain by the larval stage of the pork tapeworm. In endemic areas it is a common cause of epilepsy. Anthelmintics (albendazole or praziquantel) may be given to kill the parasites. However, there are potential adverse effects, and the parasites may eventually die without treatment., Objectives: To assess the effectiveness and safety of anthelmintics for people with neurocysticercosis., Search Strategy: In May 2009 we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2009, Issue 2), MEDLINE, EMBASE, LILACS, and the mRCT., Selection Criteria: Randomized controlled trials comparing anthelmintics with placebo, no anthelmintic, or other anthelmintic regimen for people with neurocysticercosis., Data Collection and Analysis: Two authors independently selected trials, extracted data, and assessed each trial's risk of bias. We calculated risk ratios (RR) for dichotomous variables, with 95% confidence intervals (CI). We pooled data from trials with similar interventions and outcomes., Main Results: For viable lesions in children, there were no trials. For viable lesions in adults, no difference was detected for albendazole compared with no treatment for recurrence of seizures (116 participants, one trial); but fewer participants with albendazole had lesions at follow up (RR 0.56, 95% CI 0.45 to 0.70; 192 participants, two trials).For non-viable lesions in children, seizures recurrence was less common with albendazole compared with no treatment (RR 0.49, 95% CI 0.32 to 0.75; 329 participants, four trials). There was no difference detected in the persistence of lesions at follow up (570 participants, six trials). For non-viable lesions in adults, there were no trials.In trials including viable, non-viable or mixed lesions (in both children and adults), headaches were more common with albendazole alone (RR 9.49, 95% CI 1.40 to 64.45; 106 participants, two trials), but no difference was detected in one trial giving albendazole with corticosteroids (116 participants, one trial)., Authors' Conclusions: In patients with viable lesions, evidence from trials of adults suggests albendazole may reduce the number of lesions. In trials of non-viable lesions, seizure recurrence was substantially lower with albendazole, which is counter-intuitive. It may be that steroids influence headache during treatment, but further research is needed to test this.

Purpose: To illustrate the value of cross-sectional imaging (CT, MRI) for the diagnosis and follow-up of intracranial hydatid cysts in children., Materials and Methods: Retrospective study of 9 cases of intracranial hydatid cysts in children seen over a period of 8 years. Precontrast and postcontrast 5 mm thick axial CT images were obtained in 7 cases. Noncontrast sagittal, axial and coronal T1W and T2W images were obtained in 2 cases., Results: Mean patient age was 7.5 years. Intracranial hypertension was the main presenting clinical symptom. A single supratentorial cyst with significant mass effect upon the ventricular system and midline structures was observed in all cases. All patients underwent surgery with good outcome in all cases., Conclusion: CT is the imaging modality of choice for diagnosis and postoperative follow-up of intracranial hydatid cysts in children. MRI is most helpful for further characterization when multiple or atypical cysts are present to optimize management.

Recombinant NcPDI(recNcPDI), NcROP2(recNcROP2), and NcMAG1(recNcMAG1) were expressed in Escherichia coli and purified, and evaluated as potential vaccine candidates by employing the C57Bl/6 mouse cerebral infection model. Intraperitoneal application of these proteins suspended in saponin adjuvants lead to protection against disease in 50% and 70% of mice vaccinated with recNcMAG1 and recNcROP2, respectively, while only 20% of mice vaccinated with recNcPDI remained without clinical signs. In contrast, a 90% protection rate was achieved following intra-nasal vaccination with recNcPDI emulsified in cholera toxin. Only 1 mouse vaccinated intra-nasally with recNcMAG1 survived the challenge infection, and protection achieved with intra-nasally applied recNcROP2 was at 60%. Determination of cerebral parasite burdens by real-time PCR showed that these were significantly reduced only in recNcROP2-vaccinated animals (following intraperitoneal and intra-nasal application) and in recNcPDI-vaccinated mice (intra-nasal application only). Quantification of viable tachyzoites in brain tissue of intra-nasally vaccinated mice showed that immunization with recNcPDI resulted in significantly decreased numbers of live parasites. These data show that, besides the nature of the antigen, the protective effect of vaccination also depends largely on the route of antigen delivery. In the case of recNcPDI, the intra-nasal route provides a platform to generate a highly protective immune response.

The authors report the case of a 46-year-old woman with cerebral sparganosis resulting from infection with a larva of Spirometra. Computed tomography and magnetic resonance imaging revealed a mass lesion with prominent perifocal oedema in the left parietal lobe. Advanced imaging pulse sequences, including MR spectroscopy and MR perfusion, were performed. During surgery for the removal of a granuloma, the parasite was discovered and excised. Following treatment, the patient's neurological deficits markedly improved.

Background: Neurocysticercosis is an infection of the brain by the larval stage of the pork tapeworm. In endemic areas it is a common cause of epilepsy. Anthelmintics (albendazole or praziquantel) may be given to kill the parasites. However, there are potential adverse effects, and the parasites may eventually die without treatment., Objectives: To assess the effectiveness and safety of anthelmintics for people with neurocysticercosis., Search Strategy: In May 2009 we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2008, Issue 3), MEDLINE, EMBASE, LILACS, and the mRCT., Selection Criteria: Randomized controlled trials comparing anthelmintics with placebo, no anthelmintic, or other anthelmintic regimen for people with neurocysticercosis., Data Collection and Analysis: Two authors independently selected trials, extracted data, and assessed each trial's risk of bias. We calculated risk ratios (RR) for dichotomous variables, with 95% confidence intervals (CI). We pooled data from trials with similar interventions and outcomes., Main Results: For viable lesions in children, there were no trials. For viable lesions in adults, no difference was detected for albendazole compared with no treatment for recurrence of seizures (116 participants, one trial); but fewer participants with albendazole had lesions at follow up (RR 0.56, 95% CI 0.45 to 0.70; 192 participants, two trials).For non-viable lesions in children, seizures recurrence was less common with albendazole compared with no treatment (RR 0.49, 95% CI 0.32 to 0.75; 329 participants, four trials). There was no difference detected in the persistence of lesions at follow up (570 participants, six trials). For non-viable lesions in adults, there were no trials.In trials including viable, non-viable or mixed lesions (in both children and adults), headaches were more common with albendazole alone (RR 9.49, 95% CI 1.40 to 64.45; 106 participants, two trials), but no difference was detected in one trial giving albendazole with corticosteroids (116 participants, one trial)., Authors' Conclusions: In patients with viable lesions, evidence from trials of adults suggests albendazole may reduce the number of lesions. In trials of non-viable lesions, seizure recurrence was substantially lower with albendazole, which is counter-intuitive. It may be that steroids influence headache during treatment, but further research is needed to test this.

Hydatid disease is caused by the infestation of the larvae of tapeworms of the genus Echinococcus. The definitive hosts of Echinococcus are various carnivores, the common being the dog. All mammals (more often sheep and cattle) are intermediate hosts. Humans get infected through the feco-oral route by ingestion of food or milk contaminated by dog feces containing ova of the parasite or by direct contact with dogs. The most common sites of infestation are the liver (75%) and lungs (15%). Various authors state a frequency of hydatidosis of the brain ranging between only 0.2-4% of cases. [1],[2],[3] The prognosis following surgical intervention is good, especially in pediatric age. [2],[3] Hence early diagnosis of this condition is crucial. We report a rare case of a child with a large intraventricular hydatid cyst that had an excellent recovery following surgery.