| 摘要 |
A 22-year-old Taiwanese girl who had neither traveled abroad nor eaten raw meat was found to have features of fulminant encephalitis and progressive intracranial hypertension manifested by intractable headache, frequent nausea and vomiting for 9 months. Neurological examinations at the time of admission revealed bilateral papilledema, but no convulsions or focal signs were noted. Brain computed tomography (CT) and magnetic resonance image (MRI) showed multiple parenchymal, meningobasal calcifications, cysts as well as a right temporal scolex nodule which were compatible with mixed neurocysticercosis (NCC), both inactive and active lesions. A regimen of praziquantel (50mg/kg/tidX14days/AC) and hydrocortisone (solu-cortef, 100mg iv q6hX7days), together with a craniotomy for the parasite ball, followed by post- operative albendazole (15mg/kg/dayX8weeks/AC), successfully treated the lesions which, as evaluated by remission of symptoms and inactivation of infection shown from CT and MRI findings. Pathological examination confirmed the diagnosis of NCC. In this report, we find that: 1) MRI is more sensitive than CT in the diagnosis of active NCC and is more useful in evaluation of both degenerative change and result of treatment on the parasite. 2) Combination therapy of praziquantel, Steroid and albendazole is an effective treatment for both parenchymal and subarachnoidal NCC. 3) An intracerebral mass that remains symptomatic should be treated surgically. 4) Early recognition of this rare CNS parasite infection permits efficient medical and surgical treamtne, greatly improving the prognosis. |
