- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612
- Department of Surgery, Division of Neurosurgery, University of Arizona, Tucson, AZ 85724
Sebastian R. Herrera
Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612
DOI:10.4103/2152-7806.74188© 2010 Herrera SR This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Herrera SR, Chan M, Alaraj AM, Neckrysh S, Lemole MG, Amin-Hanjani S, Slavin KV, Charbel FT. CT Ventriculography for diagnosis of occult ventricular cysticerci. Surg Neurol Int 23-Dec-2010;1:92
How to cite this URL: Herrera SR, Chan M, Alaraj AM, Neckrysh S, Lemole MG, Amin-Hanjani S, Slavin KV, Charbel FT. CT Ventriculography for diagnosis of occult ventricular cysticerci. Surg Neurol Int 23-Dec-2010;1:92. Available from: http://sni.wpengine.com/surgicalint_articles/ct-ventriculography-for-diagnosis-of-occult-ventricular-cysticerci/
Background:Neurocysticercosis is the most common parasitic infection of the central nervous system (CNS). Intraventricular lesions are seen in 7–20% of CNS cysticercosis. Intraventricular lesions can be missed by computed tomography (CT) and magnetic resonance imaging (MRI) as they are typically isodense/isointense to the cerebrospinal fluid. We present our experience with CT ventriculography to visualize occult cysts.
Case Description:Two patients presented with hydrocephalus and suspected neurocysticercosis were evaluated with CT and MRI with and without contrast failing to reveal intraventricular lesions. CT-ventriculography was used: 10 ml of cerebrospinal fluid was drained from the ventriculostomy catheter, and 10 ml of iohexol 240 diluted 1:1 with preservative-free saline was injected through the ventriculostomy catheter. Immediate CT of the brain was performed. The first patient had multiple cysts located throughout the body of the left lateral ventricle. The second patient had a single lesion located in the body of the lateral ventricle. The CT-ventriculography findings helped in identifying the lesions and plan the surgical intervention that was performed with the aid of an endoscope to remove the cysts.
Conclusions:Intraventricular neurocysticercosis is a common parasitic disease which can be difficult to diagnose. We used CT-ventriculography with injection of contrast through the ventriculostomy catheter in two patients where CT and MRI failed to demonstrate the lesions. This technique is a safe and useful tool in the imaging armamentarium when intraventricular cystic lesions are suspected.
Keywords: Intraventricular cyst, hydrocephalus, neurocysticercosis, ventriculography
Neurocysticercosis is the most common central nervous system (CNS) parasitic infection worldwide.[
Intraventricular lesions are usually diagnosed by computer tomography (CT) or magnetic resonance imaging (MRI). However, cystic intraventricular lesions are often missed by CT because they are isodense to cerebrospinal fluid (CSF) and do not enhance with contrast.[
Technique for CT ventriculography
Ventriculostomy catheters (Hermetic-Ventricular catheter set – INS 0001, Integra Life, Plainsboro, NJ) previously implanted for management of acute hydrocephalus were used for ventriculography. Prior to the injection, CT of the head was performed to confirm that all side ports of the catheter were within the lateral ventricle. The patient was positioned supine in the CT scanner in preparation for an immediate scan. Ten milliliter of CSF was passively drained into the collection chamber in the CSF drainage system (Integra, Plainsboro, NJ) prior to the contrast injection. The side port of the drainage system was accessed with a 23-gauge needle while using standard antiseptic technique. Ten milliliter of equal mixture of iohexol 240 (GE Healthcare, Waukesha, WI) and preservative-free saline was injected slowly through the ventriculostomy catheter. Immediate CT of the brain was performed to improve visualization of the entire ventricle as the contrast media settles toward the dependent portion of the ventricle with gravity.
A 40-year-old Hispanic male was transferred to our service with a history of neurocysticercosis, hydrocephalus and ventriculoperitoneal shunt malfunction. The patient had previously undergone multiple shunt revisions and arrived on our service with a ventriculostomy catheter in place. CT without contrast failed to demonstrate intraventricular lesions. MRI raised suspicion for a T2 hyperintense lesion within the left lateral ventricle [
A 41-year-old Hispanic male presented to the emergency department with two weeks of progressive headaches, nausea and vomiting. His neurological exam was non-focal and the initial CT scan showed right lateral ventricle dilatation. A ventriculostomy was placed for management of hydrocephalus. MRI of brain failed to show lesions on T2 and T2 FLAIR weighted sequences, but a suspected cyst was visualized in the T1 with contrast sequence. [
Case #2. (a): Axial T1 with contrast magnetic resonance imaging of the brain showing enhancement in right lateral ventricle without evidence of intraventricular cysts. (b): Axial T2 weighted magnetic resonance imaging of the brain showing right ventriculostomy catheter in the lateral ventricle. No intraventricular cysts were seen.
Neurocysticercosis is the most common parasitic infection that affects the CNS.[
Four stages of the disease have been proposed: vesicular, colloid vesicular, granular nodular and nodular calcified.[
Parenchymal disease is the most common location and easily seen on MRI. The second most common site with up to 20% of the lesions is the intraventricular form of the disease.[
CT ventriculography has been previously described to diagnose intraventricular lesions.[
Intraventricular neurocysticercosis is a common parasitic disease which can be difficult to diagnose despite CT and MRI. Knowing the exact location of the disease is instrumental in treatment and surgical planning. The authors used the CT ventriculography technique with injection of contrast via the ventriculostomy catheter in two patients where the usual imaging failed to reveal the lesions. This technique is a safe and useful tool in the imaging armamentarium when cystic intraventricular lesions are suspected.
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