Resumos
Com a finalidade de conhecer os elementos úteis que o EEG poderia trazer para o diagnóstico da forma clínica da cisticercose encefálica, foram reunidos 118 casos desta afecção, com diagnóstico confirmado pela verificação cirúrgica, pelo exame do liqüido cefalorraqueano (presença de leucocitose, eosinofilia e reação de desvio de complemento positiva) ou pela verificação radiológica de cisticercos calcificados. Os resultados electrencefalográficos foram analisados particularmente visando os dados que pudessem informar sôbre existência de processo difuso envolvendo o parênquima nervoso dos hemisférios cerebrais, ou a existência de focos epileptógenos ativos, ou ainda, sinais de sofrimento do parênquima em conseqüência da hipertensão intracraniana. Êstes resultados foram estudados separadamente no grupo dos casos com síndrome clínica da convexidade cerebral, com a presença ou não de síndrome convulsiva e no grupo dos casos com síndrome clínica de base e fossa posterior. Além disso os resultados electrencefalográficos foram estudados comparativamente no grupo de pacientes com cisticercos não calcificados, assim como também foram estudados, comparativamente, em grupos de pacientes com síndrome inflamatória verificável pelo exame do líqüido cefalorraqueano e no de pacientes com o liqüido cefalorraqueano normal. Êstes resultados, projetados nos quadros 1 e 2, permitiram conclusões de algum interêsse clínico, significativas para a importância do exame electrencefalográfico na avaliação dos processos patológicos encefálicos decorrentes da neurocisticercose.
The present study has the purpose of showing the possible value of the EEG in the diagnosis of brain cysticercosis. The diagnosis of cysticercosis was based on (1) radiological calcification, (2) characteristic spinal fluid findings (increase of cells, increase of eosinophils and positive test for cysticercosis) and/or (3) neurosurgical findings. The total number of cases was 118 (14 verified by surgical approach, 35 diagnosed by X ray examination and 42 by the spinal fluid examination) : in 16 cases there were association of surgical and spinal fluid positive findings; in 4 cases there were surgical findings and X ray positive findings; in 7 cases there were spinal fluid and radiological positive findings. The surgical cases were mostly of cysticercus of the posterior fossa because of the spinal fluid blocking that asks such therapy. The patients were divided according to the localization of the cysticercus (1) on the cortical surface, (2) at the base of the brain and the posterior fossa, and (3) diffuse cysticercosis. The localization of the cysticercus was possible by the evaluation of the clinical signs, the radiological calcification or the neurosurgical finding of the cysticercus. The EEG records were analysed according to the changes possibly due to the lesion caused by the cysticercus (chronic and diffuse meningo-encephalitis of the brain surface, arachnoiditis of the base and of the posterior fossa, inflammatory reaction inside the fourth ventricle, with subsequent spinal fluid blocking and intracranial hypertension). The analysis showed: 1 - Focal paroxysmal changes have indicated the great incidence of epileptic seizures in these patients; 2 - δ waves were more frequent when the lesion was located in the posterior fossa. The meningo-encephalitis on the cerebral surface did not show EEG signs of acute brain involvement; 3 - θ waves were seen very seldom and were present only on those patients with signs of basal or posterior fossa involvement (due to intracranial hypertension probably) due to involvement of mesencephalic structure; 4 - The normal EEG was very rare in patients with cerebral cysticercosis and did not give any information regarding the localization of the cysticercus; 5 - Changes on background activity (disorganization or discrete slow waves) have been noticed in all groups of patients; 6 - In patients with diffuse cerebral cysticercosis the EEG changes (disorganization on background activity, slow waves or signs of focal activity) did not show striking difference from those patients with localized cerebral cysticercosis; 7 - The calcified cysticercus on the cerebral surface (chronic cysticercosis) was coincident more often with focal activity on the EEG, than on the group of not calcified cysticercus (recent, cysticercosis); 8 - The incidence of pathological EEG was the same on both groups (calcified and non calcified cysticercosis). The EEG on the last group showed very often δ waves.
Paulino W. Longo; Eliova ZukermanII; M. H. Franco da Rocha MoreiraIII; José Geraldo de Camargo LimaIII; Paulo Pinto PupoI; Rosa Helena LongoII; Ceme JordyIII; Giancarlo ZorliniIII
IChefe de Clinica
IIAssistente
IIIMédico interno
RESUMO
Com a finalidade de conhecer os elementos úteis que o EEG poderia trazer para o diagnóstico da forma clínica da cisticercose encefálica, foram reunidos 118 casos desta afecção, com diagnóstico confirmado pela verificação cirúrgica, pelo exame do liqüido cefalorraqueano (presença de leucocitose, eosinofilia e reação de desvio de complemento positiva) ou pela verificação radiológica de cisticercos calcificados. Os resultados electrencefalográficos foram analisados particularmente visando os dados que pudessem informar sôbre existência de processo difuso envolvendo o parênquima nervoso dos hemisférios cerebrais, ou a existência de focos epileptógenos ativos, ou ainda, sinais de sofrimento do parênquima em conseqüência da hipertensão intracraniana. Êstes resultados foram estudados separadamente no grupo dos casos com síndrome clínica da convexidade cerebral, com a presença ou não de síndrome convulsiva e no grupo dos casos com síndrome clínica de base e fossa posterior. Além disso os resultados electrencefalográficos foram estudados comparativamente no grupo de pacientes com cisticercos não calcificados, assim como também foram estudados, comparativamente, em grupos de pacientes com síndrome inflamatória verificável pelo exame do líqüido cefalorraqueano e no de pacientes com o liqüido cefalorraqueano normal.
Êstes resultados, projetados nos quadros 1 e 2, permitiram conclusões de algum interêsse clínico, significativas para a importância do exame electrencefalográfico na avaliação dos processos patológicos encefálicos decorrentes da neurocisticercose.
SUMMARY
The present study has the purpose of showing the possible value of the EEG in the diagnosis of brain cysticercosis. The diagnosis of cysticercosis was based on (1) radiological calcification, (2) characteristic spinal fluid findings (increase of cells, increase of eosinophils and positive test for cysticercosis) and/or (3) neurosurgical findings. The total number of cases was 118 (14 verified by surgical approach, 35 diagnosed by X ray examination and 42 by the spinal fluid examination) : in 16 cases there were association of surgical and spinal fluid positive findings; in 4 cases there were surgical findings and X ray positive findings; in 7 cases there were spinal fluid and radiological positive findings. The surgical cases were mostly of cysticercus of the posterior fossa because of the spinal fluid blocking that asks such therapy. The patients were divided according to the localization of the cysticercus (1) on the cortical surface, (2) at the base of the brain and the posterior fossa, and (3) diffuse cysticercosis. The localization of the cysticercus was possible by the evaluation of the clinical signs, the radiological calcification or the neurosurgical finding of the cysticercus.
The EEG records were analysed according to the changes possibly due to the lesion caused by the cysticercus (chronic and diffuse meningo-encephalitis of the brain surface, arachnoiditis of the base and of the posterior fossa, inflammatory reaction inside the fourth ventricle, with subsequent spinal fluid blocking and intracranial hypertension).
The analysis showed: 1 - Focal paroxysmal changes have indicated the great incidence of epileptic seizures in these patients; 2 - δ waves were more frequent when the lesion was located in the posterior fossa. The meningo-encephalitis on the cerebral surface did not show EEG signs of acute brain involvement; 3 - θ waves were seen very seldom and were present only on those patients with signs of basal or posterior fossa involvement (due to intracranial hypertension probably) due to involvement of mesencephalic structure; 4 - The normal EEG was very rare in patients with cerebral cysticercosis and did not give any information regarding the localization of the cysticercus; 5 - Changes on background activity (disorganization or discrete slow waves) have been noticed in all groups of patients; 6 - In patients with diffuse cerebral cysticercosis the EEG changes (disorganization on background activity, slow waves or signs of focal activity) did not show striking difference from those patients with localized cerebral cysticercosis; 7 - The calcified cysticercus on the cerebral surface (chronic cysticercosis) was coincident more often with focal activity on the EEG, than on the group of not calcified cysticercus (recent, cysticercosis); 8 - The incidence of pathological EEG was the same on both groups (calcified and non calcified cysticercosis). The EEG on the last group showed very often δ waves.
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Trabalho do Serviço de Neurologia da Escola Paulista de Medicina (Prof. Paulino W. Longo).
Nota dos autores - Parte do material dêste trabalho foi apresentado ao Congresso da Sociedade Brasileira de Neurologia, Psiquiatria e Higiene Mental (Salvador, Bahia), 1958.
Serviço de Neurologia da Escola Paulista de Medicina - Caixa Postal 5496 - São Paulo, Brasil.
- 1. FERRARI, D. - EEG observations in case of human cerebral cysticercosis. The Italian EEG Soc, reunião anual (4 julho, 1954). In EEG Clin. Neurophysiol., 6:533, 1954.
- 2. LA RIVA, F. Isamat de - Cisticercosis Cerebral. Vergara S.A., Barcelona, 1957 (págs. 93-95).
- 3. PUPO, P. P.; CARDOSO, W.; REIS, J. B.; PEREIRA DA SILVA, C. - Sobre a cisticercose encefálica: estudo clínico, anátomo-patológico, radiológico e do liqüido cefalorraqueano. Arq. Assist. Geral a Psicopatas de São Paulo, 10-11:3-123 (janeiro-dezembro) 1945-1946.
- 4. TRELLES, J. O.; LAZARTE, J. - La Cisticercosis Cerebral. Empresa Periodista S.A., Lima (Peru), 1941.
Aspectos electrencefalográficos da cisticercose encefálica
Datas de Publicação
-
Publicação nesta coleção
09 Dez 2013 -
Data do Fascículo
Dez 1959
