Update: Neurocysticercosis

Twenty-six patients with cysticercosis of the brain parenchyma were treated with the antihelmintic agent praziquantel (50 mg per kilogram of body weight daily for 15 days). During treatment a strong inflammatory reaction occurred, as evidenced by increased protein and cells in the cerebrospinal fluid. This finding correlated with headache, exacerbation of neurologic symptoms, and edema and inflammation around cystic lesions. After three months of treatment all patients had improved clinically, and 13 (50 per cent) were asymptomatic. The total number of cysts on CT scans had decreased from 152 at the beginning of treatment to 51, and the mean diameter of cysts was reduced by 72 per cent. CT scans showed improvement in 25 of the 26 patients, with total remission of all cysts in nine. Seventeen control patients followed with CT studies for a mean of 9 +/- 2 months had no spontaneous remission of lesions, and in many cases the scans showed worsening during the observation period. Our results indicate that praziquantel is effective in cysticercosis of the brain parenchyma.

Sotelo J, Escobedo F, Rodriguez-Carbajal J, Torres B, Rubio-Donnadieu F. Therapy of parenchymal brain cysticercosis with praziquantel. N Engl J Med. 1984 Apr 19;310(16):1001-7. PubMed PMID: 6708975.

Update: Chiari Type 1

In a series of 71 patients, pain was the commonest symptom (69% of patients); other symptoms included weakness (56%), numbness (52%), and unsteadiness (40%). The presenting physical signs consisted of a foramen magnum compression syndrome (22%), central cord syndrome (65%), or a cerebellar syndrome (11%). Myelography was performed in 69 patients, and was the most useful investigation. Only 23% of plain radiographs were abnormal. In addition to tonsillar descent, the operative findings included arachnoid adhesions (41%) and syringomyelia (32%). All patients underwent suboccipital craniectomy and C1-3 laminectomy. Respiratory depression was the most frequent postoperative complication (14%), and one patient died from sleep apnea. Early postoperative improvement of both symptoms (82%) and signs (70%) was followed by later relapse in 21% of patients, showing an initial benefit following surgery. None of the patients with a cerebellar syndrome deteriorated, whereas 56% of patients with evidence of foramen magnum compression and 66% of those with a central cord syndrome maintained their initial improvement. The authors conclude that posterior fossa decompression appears to benefit some patients, although a significant proportion might be expected to relapse within 2 to 3 years after operation, depending upon the presenting syndrome 1)
1) Paul KS, Lye RH, Strang FA, Dutton J. Arnold-Chiari malformation. Review of 71 cases. J Neurosurg. 1983 Feb;58(2):183-7. PubMed PMID: 6848674.

Taylor-Haughton line revisited

Taylor Haughton line

In 1900 Taylor and Haughton described a technique to define a line on the scalp directly above the central fissure 1)
1. Draw a Nasion-Inion line ( Nasion – Just below Glabella and Inion -External Occipital protruberance)
2. Divide the Nasion-Inion line in to 25%, 50% and 75%
3. Bregma is the point between the 25% and 50% points and Lambda is at 75% point
4. Sylvian fissure is drawn from the orbitotemporal angle (A point of depressin where eyebrow ends) to the 75% point on naso-inion line.
5. Draw a line perpendicular to the root of the zygoma starting at preauricular point
6. Central sulcus is drawn from 54% point on naso-inion line to the point where the sylvian line cuts the perpendicular line
The Taylor-Haughton line was used to identify the central fissure in computed tomography (CT) images. Radiopaque catheters are placed on the scalp on either side of the Taylor-Haughton line prior to CT imaging. The accuracy of the Taylor-Haughton line for identifying the central fissure was also investigated in cadaver brains. The Taylor-Haughton line provides a good approximation of the location of the rolandic fissure 2)
1) Taylor EH,Haughton WS.Some recent researchers on the topography of the convolutions andfissures of thebrain.Trans R Acad Med Ireland 1900;18:511-522
2) Taylor AJ, Haughton VM, Syvertsen A, Ho KC. Taylor-Haughton line revisited. AJNR Am J Neuroradiol. 1980 Jan-Feb;1(1):55-6. PubMed PMID: 6779590.
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