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Vol. 18. Issue 2.
Pages 101-110 (January 2007)
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Vol. 18. Issue 2.
Pages 101-110 (January 2007)
Dificultades diagnósticas y terapéuticas en la neurocisticercosis: Presentacion de 6 casos y revisión de la literatura
Diagnostic and therapeutic difficulties in neurocysticercosis: presentation of 6 cases and review of the literature
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J. Enseñat, R. Martínez-Mañas
, E. Ferrer
Servicio de Neurocirugía. Hospital Clinic i Provincial. Barcelona
J.P. Horcajada*, C. De Juan**
* Servicio de Enfermedades Infeciosas. Hospital Clinic i Provincial. Barcelona
** Servicio de Neurorradiología Hospital Clinic i Provincial. Barcelona
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Resumen
Introducción

La neurocisticercosis (NCC) es una patología emergente en países desarrollados debido principalmente, al aumento de la inmigración desde áreas endémicas. El gran poliformismo de la NCC hace necesaria la individualización del tratamiento en cada caso. La toma de decisiones en paises no habituados a esta patología puede ser compleja.

Objetivos

Establecer unas pautas diagnósticas y terapéuticas en los diferentes tipos de NCC.

Material y métodos

Se ha realizado un análisis descriptivo y retrospectivo de seis casos de neurocisticercosis atendidos en el Servicio de Neurocirugía del Hospital Clínic de Barcelona desde 1992 al 2000 (ambos incluidos). Se realiza una revisión de la literatura sobre los métodos diagnósticos y terapéuticos actuales en las diferentes modalidades de NCC.

Discusión

El diagnóstico definitivo o probable de NCC se realiza en función de criterios clínicos, inmunológicos, radiológicos y epidemiológicos. En pacientes con enfermedad inactiva se recomienda únicamente tratamiento sintomático. No hay datos concluyentes sobre el beneficio del tratamiento con antiparasitarios en la enfermedad activa parenquimatosa, sin embargo, los pacientes con enfermedad activa extraparenquimatosa se pueden beneficiar del tratamiento antihelminítico asociado a corticoides durante los primeros días. El tratamiento quirúrgico está indicado en lesiones que provocan focalidad neurológica progresiva, hipertensión endocraneal o hidrocefalia.

Palabras clave:
Neurocisticercosis
Terapia antiparasitaria
Cirugía
EITB
ELISA
Abreviaturas:
AC
Ag
DVP
EITB
ELISA
HbsAg
HIV
HTIC
IG
LCR
NCC
RM
SN
SNC
TC
VHC
Summary
Introduction

The incidence of neurocysticercosis (NCC) is increasing currently in developed countries due to the migration movements from endemic countries. Due to NCC polymorphism, treatment would be individualized in each case. Countries not used to this disease have to deal with.

Goals

To set up diagnostic and therapeutic guidelines in all sorts of NCC and choose the correct treatment would be challenging.

Patients and methods

To perform a descriptive and retrospective analysis of six cases of NCC seen in the Neurosurgery Department of the Hospital Clinic de Barcelona from 1992 to 2000 (both included). We have performed a revision of the literature about diagnostic and therapeutic methods.

Discussion

Definitive or probable diagnosis of NCC is based on clinical, imaging, immunological, and epidemiological criteria. In patients with inactive disease only symptomatic treatment is indicated. In active parenchymal forms there are not consensus if antiparasitic treatment is indicated. However, in extraparenchymal active disease aggressive treatment with antiparasitic agents and steroids is recommended. In cases of intracranial hypertension, neurological deficits or hydrocephalus surgery is the treatment of choice.

Key words:
Neurocysticercosis
Antiparisitic drugs
Surgery
EITB
ELISA

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