Continuum : lifelong learning in neurology
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Neurocysticercosis occurs when humans become intermediate hosts in the life cycle of Taenia solium by ingesting its eggs directly from a taenia carrier or, less often, by contaminated food. Within the nervous system, cysticerci may lodge in the brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing a number of pathologic changes that are responsible for the pleomorphism of neurocysticercosis. This article discusses the clinical manifestations, diagnosis, and treatment of neurocysticercosis. ⋯ Neurocysticercosis is the most common helminthic infection of the CNS and a major cause of acquired epilepsy worldwide. Diagnosis of neurocysticercosis is possible after interpretation of clinical data together with findings of neuroimaging studies and results of immunologic tests in a proper epidemiologic context. The use of cysticidal drugs reduces the burden of infection in the brain and improves the clinical course of most patients. Further efforts must be directed to eradicate the disease through the implementation of control programs against all interrelated steps in the life cycle of T. solium, including human carriers of the adult tapeworm, infected pigs, and eggs in the environment.
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This article describes the background, clinical presentation, diagnosis, and treatment of selected etiologies of subacute and chronic meningitis. Key diagnostic considerations when evaluating a patient presenting with chronic inflammation of the CNS are discussed, and several specific infectious, neoplastic, and autoimmune etiologies are reviewed in detail. ⋯ Meningitis is defined as inflammation involving the meninges of the brain and spinal cord. Meningitis can be categorized as acute, subacute, or chronic based on duration of inflammation. This article focuses on the most common causes of subacute and chronic meningitis. Chronic meningitis is commonly defined as inflammation evolving during weeks to months without resolution of CSF abnormalities. Determining the time course of meningitis is important for creating a differential diagnosis. Most organisms causing acute meningitis rarely persist more than a few weeks. Although numerous etiologies of subacute and chronic meningitis have been identified, this article focuses on the most common etiologies: (1) infectious, (2) autoimmune, and (3) neoplastic.
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Continuum (Minneap Minn) · Dec 2012
Review Case ReportsEncephalitis and postinfectious encephalitis.
Encephalitis and postinfectious encephalitis represent two important conditions for the neurologist, both in terms of their presentations as neurologic emergencies and their potential to cause death or serious neurologic impairment. This article reviews the major infectious and noninfectious causes of encephalitis and discusses postinfectious encephalitis as an indirect effect of systemic illness. ⋯ Encephalitis and postinfectious encephalitis present as neurologic emergencies requiring prompt diagnosis and initiation of treatment. Important concerns are to identify infectious conditions requiring antibiotic or antiviral therapy and postinfectious or other autoimmune encephalitides requiring immunosuppression.