Neurocysticercosis and shunt malfunctions.

To the Editor: The existence of ventricular shunt malfunctions among patients with neurocysticercosis, mentioned by Psarros et al in the October issue of the Southern Medical Journal, has been previously reported. (1) This is well known to be related to the inflammatory reaction within the subarachnoid space in patients with cysticercotic arachnoiditis, independent of the stage of the infection, and that is the reason why patients with hydrocephalus due to cysticercotic arachnoiditis frequently have a poor prognosis, since the mortality in these patients is directly related to the number of surgical interventions done to replace the shunt. (2)

Previous studies have demonstrated that interventions such as the use of antihelmintics have not been successful in decreasing the inflammatory reaction; but apparently, continued administration of prednisone may reduce the risk of shunt dysfunction. (3) However, the most important advance toward solving this important problem has been the development of a new shunt, one that functions at a constant flow without a valvular mechanism, since the inversion of CSF transit is one of the most common causes of shunt dysfunction, as it allows the entrance of subarachnoid inflammatory cells and parasitic debris inside the ventricular cavities. Initial series and a comparison study of the Sotelo shunt with the Pudenz-type found a surprising effectiveness. (4,5)

I have a new philosophy. I'm only going to dread one day at a time.
--Charles M. Schulz

References

1. Colli BO, Pereira CU, Assirati JA, et al. Cysticercosis of the central nervous system: I. Surgical treatment of cerebral cysticercosis: a 23 years experience in the hospital das clinicas of Riberao Preto Medical School. Ar Qneuropsiquiat 1994;52:166-86.

2. Sotelo J, Marin C. Hydrocephalus secondary to cysticercotic arachnoiditis: a long-term follow-up review of 92 cases. J Neurosurg 1987;66:686-689.

3. Roman RAS, Soto-Hernandez JL, Sotelo J. Effects of prednisone on ventriculo-peritoneal shunt function in hydrocephalus secondary to cysticercosis: a preliminary study. J Neurosurg 1996;84:629-633.

4. Sotelo J, Rubalcava MA, Gomez-Llata S. A new shunt for hydrocephalus that relies on CSF production rather than on ventricular pressure: initial clinical experience. Surg Neurol 1995;43:324-332.

5. Sotelo J. Update: the new ventriculoperitoneal shunt at the Institute of Neurology of Mexico. Surg Neurol 1996;46:19-20.

Jorge G. Burneo, MD

UAB Epilepsy Center

Department of Neurology

University of Alabama at Birmingham 

Birmingham, AL