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    Successful

    ChineseMedicalJournal2003;116(4):637-638?637? ;Successfultreatmentofisolatedcerebellarcysticercosiswithalbendazole

    ;ZHULiping朱利平,SHIYaozhong石尧忠,PANXiaozhang潘孝彰,MOLing莫凌

    andWENGXinhua翁心华

    ;Neurocysticercosis(NCC)isaparasiticdiseaseofthe ;centralnervoussystem(CNS)foundworldwide.NCC

    ;isthemostcommoncauseofparasiticinfectionofCNSin ;ChinPatientswithNCCaretreatedsuccessfullywith ;chemotherapy.However.isolatedcysticlesionssitedin ;thecerebellumareusuallytreatedbydirectsurgical ;excisionasaprimarytherapeuticmodality.Wepresent ;hereacaseofisolatedcerebellarvermiscysticercosis ;successfullytreatedwithalbendazole.

    ;CASEREPoRT

    ;A39yearoldmanhadnausea.vomiting.vertigoand ;mildgaitdisturbancefortwoweeks,andwasadmittedto ;thishospitalinMarch.2O0o.Hehadnofever.headache ;andseizures,nopapilledemaandotherneurologicalfocal ;findingsonadmission.Hissymptomsgrewworseonthe ;dayofadmission,vomitingabout30timesperday. ;Treatmentwith20%mannitolandantivomitingdrugs

    ;wereineffective.TheT1weightedaxialandcoronal

    ;magneticresonanceimaging(MRIgadolinium)revealed

    enhancedlesionoflowsignalintensitybeing ;alargering

    ;1.0cminsizeinthecerebellarvermis(Fig.1). ;ExaminationofthecerebralspinalfluidfCSF)showed ;thatwhitebloodcellcount.proteinandglucose ;concentrationwerenorlna1.Theenzymelinked

    ;immunosorbentassayofCSFandserumwerepositivefor ;cysticercosis.Toreducetheintracranialpressure.he ;received20%mannitol250mltwiceadayforthreedays ;andsubsequently20%mannitol250mlQidand

    ;dexamethasone2.5mgBidintravenously.Meanwhile,he ;wastreatedwithalbendazoleatanaveragedoseof15mg/ ;kgbodyweightperday,10dayspercourse,withthree ;coursesgiyenwithathreeweekbreakbetweeneach

    ;course.Thealbendazolewasequallydividedintotwo ;dosesdailybeforethemedicationwasgiyen.Duringthe ;firstcourse.albendazolewasinitiatedat25mgand

;graduallyincreasedto800mgperday.Through48hour

    ;anticysticercustherapy,thepatient’smildheadache

    ;disappearedwiththeinfusionofadditional20%mannitol ;250mlanddexametha$one5mgintravenously.The ;syndromeofdizziness,nauseaandvomitingdisappeared ;inoneweek.Accordingly.dexamethasonewasreduced ;graduallyatthefollowup.Thepatientwasreadmitted3

    ;weekslaterforthesecondCOUrsealbendazoletherapy.

    ;HehadnoabnormalsignsandCSFreexaminationwasin ;thenormalrange.Beforestartingthesecondcourse

    ;albendazole.cranialMRIshowedthatthesizeofthecyst ;haddecreasedslightly(Fig.2).Threeweekslater,the ;sameanticysticercustherapywasrepeatedforathird ;course.Noabnormalsymptomsandsignsonadmission. ;CSFexaminationshowednorma1.Duringthelastcourse ;ofmedication.thepatientdidwellandmaintaineda ;stableconditionforsixmonthsaftertheterminationof ;therapy.Asaresult,thecystinthecerebellarvermis ;obviouslydecreasedinsizeonMRI(Fig.3).

    ;DISCUSSION

    ;AsaparasiticinvasionofCNS.NCCissporadicand ;usuallyinthisformofcysticercosis.ilethe ;involvementofcerebellarvermisisrare.thepresentation ;incranialscanmaysimulateanastrocytoma,epidermoid, ;cysticschwannoma,cysticmeningiomaorarachnoidcyst. ;Thus,itmayleadtomisdiagnosis.Therefore,wesuggest ;t}lattheformofthisdiseaseshouldbeconsideredwhen ;oneattenptstocharacterizecerebellarneoplasmsas ;detectedbybrainscan,especiallyinthosegeographical ;areaswithhighprevalenceofneurocysticercosis. ;Ddirectexcisionhasbeenattemptedasthetreatmentof ;choicefortheisolatedcerebellarcysticlesionsduetopoor ;diagnosisandhasnotbeenproventobesuperior, ;whichisevidencedbythefactthatthediseasemayturn ;DepartmentofInfectiousDiseases,HuashanHospita1.Fudan ;University,Shanghai200040,China(ZhuIJP,SlliYZ,PanXZ, ;MoLandWengXH)

    ;Correspondenceto:Dr.ZhuLiping,DepartmentofInfectious ;Diseases,HuaShanHospital,FudanUniversity,Shanghai200040, ;China(Tel:86-2154037193.Fax:86-212489015.Email: ;lipingzhu@cifiz.net)

    ;

    ;?

    ;638?ChineseMedicalJournal2003;116(4):637-638

;rig.1.MR/pre-treatmentconl~rlTlsalargecysticlesionwithinthecerebellum.

    ;rig.2.MR/showedthesizeofthecystreducedslightlyonemonthlater. ;rig.3?MR/showedthecystwithinthecerebellarvermisobviouslydecreasedinsizeafteralbendazoletre

    atment.

    ;outtobechronicorcomplicatedwithlethalclinical ;progressionfollowingsurgery.Catapanoetaltreateda ;caseofleftcerebellarcysticmasswithanti.cysticercus ;chemotherapyofhighdosagesofdexamethasone

    ;(40ms/d)andpraziquantel(1200mgeveryeighthours ;orally).Thepatientshowedminimalimprovementfor ;threedaysandendedwithaposteriorfossacraniotomv. ;inwhichtheleftcerebellarlesionwasremovedtodeviate ;herniation.Inourcase,thepatientwastreatedwith ;albendazoleatthedosageof150ms/kgforthreecourses, ;andheexperiencedminimaldruginducedsideeffects

    ;duringthetherapy.nlepatientWasfreefromneurological ;symptomsandsigns.AseriesofcranialMRIalsoshowed ;thatthecysticlesiondecreaseddramatically.Ofnote. ;calcificationofthecysthasnotyetoccurredduringthe ;followuDexaminations.

    ;PrimarycerebellarinvolvementofNCCisrareand,in ;literature,thereisnotanyotherreportedcaseinthe ;vermisalone.ThisunusualcaseremindsUSthatthe ;cysticercusmaybeadifferentialdiagnosisofcerebellar ;lesions.Ourexperiencealsoshowedthatalbendazoleis ;usefulinthetreatmentofcerebellarcysticerosis,even ;thoughthediseasecanbeapproachedwithsurgery. ;REFERENCES

    ;1.WhiteACJr.Neurocysticercosis:updatesonepidemiology. ;pathogenesis,diagnosis,andmanagement.AnnuRevMed ;20o0;51:187206.

    ;2.McCormickGF,ChiShingZee,HeidenJ,eta1.

    ;Cysticercosiscerebri.Reviewof127cases.ArchNeurol ;1982;39:534539.

    ;3.SinghS,GibikoteSV,BannurU,eta1.Cysticercosisofthe ;cerebellopontineanglecisternmimickingepidermoidinclusion ;cyst.ActaNeurolScand1999:99:260263.

    ;4.NiiY,NakagawaH,TakiT,NakabayashiSuccessful ;treatmentofcerebralcysticercosiswithpraziquante1.No ;ShinkeiGeka1988;16:1083.1088.

    ;5.CatapanoMS,MflrxJA.Centralnervoussystemcysticercosis ;simulatinganacutecerebenarhemorrhage.AnnEmergMed ;1986:15:847.849.

    ;(ReceivedMay21,2002)

;本文编辑:杨振铎刘冬云

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