CASE REPORT
Introdução: a neurocisticercose é a infecção mais comum do sistema nervoso central e é causada pela Taenia solium. Os sintomas variam dependendo da localização da lesão no cérebro. O ângulo pontocerebelar é uma localização rara de cisticercose. Apenas 14 casos foram notificados. Relato de caso: um homem de 50 anos apresentou cefaleia e neuralgia do trigêmeo facial esquerdo. Ele tinha história prévia de hidrocefalia e a escala de coma de Glasgow foi 14. Havia hipoestesia facial esquerda e paralisia facial periférica esquerda. A ressonância magnética mostrou múltiplas lesões císticas no espaço extra-axial localizadas no ângulo pontocerebelar esquerdo e na fissura silviana direita. O paciente foi submetido a tratamento cirúrgico. Conclusão: a neurocisticercose do ângulo pontocerebelar é uma entidade rara que determina sintomas graves e o risco de morbimortalidade em longo prazo dos pacientes. Apenas 15 casos foram relatados na literatura e existem diferentes opções de tratamento, incluindo o nosso.
Background: neurocysticercosis is the most common Central Nervous System infection and is caused by Taenia solium. The symptoms vary depending on the lesion’s localization in the brain. The cerebellopontine angle is a rare location of cysticercosis. Only 14 cases were reported. Case presentation: a 50-year-old man presented headache and left facial trigeminal neuralgia. He reported a previous history of hydrocephalus. Glasgow coma scale was 14. There was left facial hypoesthesia and left peripherical facial palsy. MRI showed multiple cystic lesions in the extra-axial space localized on the left cerebellopontine angle and the right Sylvian fissure. The patient was submitted for surgical treatment. Conclusion: cerebellopontine angle neurocysticercosis is a rare entity that determines severe symptoms and the risk of long-time morbidity and mortality of patients. Only 15 cases were reported in the Literature and different treatment options exist, including ours.
1. Lopez Albo W. Clinical aspects of cysticercosis of the central nervous system. Monterrey Med. 1946;123:2720-32. PMid:20988836.
2. Choudhary A, Kaushik K, Ahuja A, Varshney R, Sharma R, Phulware RH. Neurocysticercosis superimposing schwannoma: a unique combination of 2 pathologies at cerebellopontine cistern. World Neurosurg. 2021;146:205-9. http://dx.doi.org/10.1016/j. wneu.2020.10.111. PMid:33342760.
3. Gripper LB, Welburn SC. Neurocysticercosis infection and disease–a review. Acta Trop. 2017;166:218-24. http://dx.doi.org/10.1016/j. actatropica.2016.11.015. PMid:27880878.
4. Kumar S, Garg A, Handa A. Large cysticercus in the cerebellopontine angle: case report. Indian J Neurosurg. 2018;7(2):147-9. http://dx.doi. org/10.1055/s-0036-1596040.
5. Pandita KK, Razdan S. Finding the hidden cerebellopontine angle neurocysticercosis. J Assoc Physicians India. 2019;67(1):78-9. PMid:30935182.
6. Revuelta R, Soto-Hernandéz JL, Vales LO, González RH. Cerebellopontine angle cysticercus and concurrent vascular compression in a case of trigeminal neuralgia. Clin Neurol Neurosurg. 2003;106(1):19-22. http://dx.doi.org/10.1016/j.clineuro.2003.07.001. PMid:14643911.
7. White AC Jr, Garcia HH. Updates on the management of neurocysticercosis. Curr Opin Infect Dis. 2018;31(5):377-82. PMid:30095486.
8. Aguiar PH, Miura FK, Napoli PR, et al. Neuralgia do trigêmeo bilateral por cisticerco racemoso unilateral no ângulo-ponto cerebelar: relato de caso. Arq Neuropsiquiatr. 2000;58(4):1138-41. http://dx.doi. org/10.1590/S0004-282X2000000600026. PMid:11105087.
9. Chang JH, Chang JW, Park YG, Kim TS. Cysticercosis of cerebellopontine cistern: differential diagnosis using MRI. Acta Neurochir. 2004;146(4):325-8. http://dx.doi.org/10.1007/s00701-003- 0184-1. PMid:15057525.
10. Celis MA, Mourier KL, Polivka M, et al. Cysticercose cisternale de l’angle ponto-cérébelleux. Observation d’un cas opéré et revue de la littérature. Neurochirurgie. 1992;38(2):108-12. PMid:1603232.
11. del Brutto OH. Cysticercosis of the cerebellopontine angle: treatment with single-dose praziquantel. Rev Neurol. 2000;31(9):835-7. PMid:11127085.
12. Jarupant W, Sithinamsuwan P, Udommongkol C, Reuarrom K, Nidhinandana S, Suwantamee J. Spinal cord compression and bilateral sensory neural hearing loss: an unusual manifestation of neurocysticercosis. J Med Assoc Thai. 2004;87(10):1244-9. PMid:15560705.
13. Karegowda LH, Shenoy PM, Prakashini K, Karur G. A rare case of racemose neuro- cysticercosis of the posterior fossa. BMJ Case Rep. 2014;2014:bcr2014203955. http://dx.doi.org/10.1136/bcr-2014-203955. PMid:24862421.
14. Revuelta R, Juambelz P, Balderrama J, Teixeira F. Contralateral trigeminal neuralgia: a new clinical manifestation of neurocysticercosis. Case report. Neurosurgery. 1995;37(1):138-40. http://dx.doi. org/10.1227/00006123-199507000-00022. PMid:8587675.
15. Singh S, Gibikote SV, Bannur U, Chacko G, Korah IP, Rajshekhar V. Cysticercosis of the cerebellopontine angle cistern mimicking epidermoid inclusion cyst. Acta Neurol Scand. 1999;99(4):260-3. http://dx.doi. org/10.1111/j.1600-0404.1999.tb07359.x. PMid:10225360.
16. Song L, Guo F, Ma S, Song Z, Wu L, Sun H. A rare presentation of intracranial cysticercosis involving the cerebellopontine angle. J Clin Neurosci. 2013;20(6):892-4. http://dx.doi.org/10.1016/j. jocn.2012.05.046. PMid:23477872.
17. Yang SY, Vásquez CM. Hemifacial spasm secondary to arachnoiditis due to neurocysticercosis: clinical image. World Neurosurg. 2020;143:180-2. http://dx.doi.org/10.1016/j.wneu.2020.06.217. PMid:32645374.
18. Del Brutto OH, Rajshekhar V, White AC Jr, et al. Proposed diagnostic criteria for neurocysticercosis. Neurology. 2001;57(2):177-83. http:// dx.doi.org/10.1212/WNL.57.2.177. PMid:11480424.
19. Samii M, Tatagiba MS, Piquer J, Carvalho GA. Surgical treatment of epidermoid cysts of the cerebellopontine angle. J Neurosurg. 1996;84(1):14-9. http://dx.doi.org/10.3171/jns.1996.84.1.0014. PMid:8613823.
1MD, Neurosurgeon, Department of Neurosurgery, General Hospital of Fortaleza, Fortaleza, CE, Brazil.
2MD, Otolaryngologist, Department of Otolaryngology, Leonardo da Vinci Hospital, Fortaleza, CE, Brazil.
Received Mar 14, 2023
Accepted Apr 4, 2023
