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    Intraventricular Neurocysticercosis: Experience and Long-Term Outcome from a Tertiary Referral Center in the United States

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    Author
    Nash, TE; Ware, JM; Mahanty, S
    Date
    2018-01-01
    Source Title
    American Journal of Tropical Medicine and Hygiene
    Publisher
    AMER SOC TROP MED & HYGIENE
    University of Melbourne Author/s
    Mahanty, Siddhartha
    Affiliation
    Doherty Institute
    Metadata
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    Document Type
    Journal Article
    Citations
    Nash, T. E., Ware, J. M. & Mahanty, S. (2018). Intraventricular Neurocysticercosis: Experience and Long-Term Outcome from a Tertiary Referral Center in the United States. AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE, 98 (6), pp.1755-1762. https://doi.org/10.4269/ajtmh.18-0085.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/255360
    DOI
    10.4269/ajtmh.18-0085
    Abstract
    Ventricular involvement in neurocysticercosis (NCC), a common serious manifestation of NCC, has distinct clinical presentations, complications, and treatments primarily because of partial or complete obstruction of the cerebrospinal fluid (CSF) flow by Taenia solium cysts. We review the clinical course, treatments, and long-term outcomes in 23 of 121 (19.0%) total NCC patients with ventricular cysts referred to the National Institutes of Health from 1985 to the October 2017. Patients had a median age of 31.8 (range: 22.4-52.6 years), were 60.9% male, diagnosed a median of 6.5 years (range: 0.17-16 years) after immigration, and were followed for a median of 3.6 years (range: 0.1-30.5 years). Other forms and manifestations of NCC were present in 73.9% (17/23). The fourth ventricle was involved in a majority (15/23, 65.2%) resulting in hydrocephalus (73.9%), ventriculitis, and periventricular edema (7/23, 30.4%). Cystectomy was accomplished in 60.9%, usually by removal of a fourth ventricular cyst through a suboccipital craniotomy. Nonresectable cysts were treated medically. Ventriculoperitoneal shunts were inserted in 43.5% (10/23) and failed in four, three from infection. Other complications included surgically induced injuries (4/23, 17.4%) and entrapment of a lateral ventricle (2/23, 8.7%). Despite a common severe early course, 90.9% (20/22) stabilized without recurrence, 15% (3/20) complained of mild-to-moderate neurological complaints, and 15% (3/20) were significantly disabled. Four patients who underwent removal of ventricular cysts without significant other NCC and who received with no cysticidal treatment became CSF cestode antigen negative without recurrence indicating that after successful extraction of cysts, additional cysticidal treatment may not be needed.

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