Abstracts

Brain calcifications (BC) occur in late stages of several infectious-inflammatory diseases, especially of neurocysticercosis (NCC). Several case reports show their association to perilesional edema and neurological symptoms.Our objective was to determine clinical, neuroimaging and outcome of patients with BC with perilesional edema.
Twenty-three patients with BC were collected from one public and two private neuroimaging departments during a 4 year period. Data from the history, physical examination, electroencephalograms and neuroimagings were reviewed. Diagnostic and classification criteria for NCC of Sotelo (1985), Del Brutto (1998), and Sanchez and Medina (1999) were followed. Non-pathological, non-inflammatory and non-cysticercotic postinfectious calcifications were also considered.
The majority of patients were women 16/23 or 76%. Average age was 29 years (range 2 to 68), in 28% of cases concomitant lesions indicated several stages of NCC. The main symptoms prompting referral were seizures 64% (n=14), a previous diagnosis of NCC 50% and neurological complications, 50% (n=11), and headaches 18% (n=2). EEG findings correlated with localization of lesions in 4 cases whose EEGs were available and consisted of: focal slow waves in 4, and focal epileptic activity manifested by spikes or sharp waves in 2. One patient had a brain biopsy showing gliosis. Thirty-four percent of patients (8/23) had brain imaging follow-up showing resolution of edema by the first month with steroid treatment. Recurrences were documented in 4/23 patients (17.4%), the main manifestations being seizures and headache.
Our series suggests a new stage of neurocysticercosis namely brain calcification with perilesional edema, caracterized clinically by epileptic seizures and headaches, with electroclinical correlation. Perilesional edema, seizures and headaches resolve with steroids but can recurr months and years later. Mechanisms for this phenomena is unknown.
[Supported by: Instituto Neurociencias, Tegucigalpa, Honduras]