A Review of Cysticercosis

SNI, Surgical Neurology International,

and SNI Digital Innovations in Learning.

In association with the Sub-Saharan African neurosurgeons

are pleased to present the second monthly Sub-Saharan Africa International Neurosurgery Grand Rounds on the topic of global solutions to clinical challenges in neurosurgery.

This Grand Rounds was held on Sunday July 7, 2024.

This talk will be presented by Professor Katanga, DU, Mayor C. Kabula, head of the Jason Sendway General Hospital,

and also at the Coptic Provincial Hospital. He's also on the staff at the University of Zimbabwe and the University of Lubumbashi in

the Democratic Republic of the Congo. The talk is on sister circosis, a review. Yes, let's get started. Thank you, everyone, for joining. This is the second

SNI digital global international

conference but we have a forum where we can learn about what's happening in neurosurgery around Sub-Saharan Africa. The first conference was a success, and we're building on that. I think we've

had some glitches along the way that I think we've refined, and so we will continue to build

We have a couple of presenters.

Dr. Cabullo will be talking about intraoperative ultrasound in neurosurgery and followed by Dr. Cabullo talking about neurosister psychosis, surgical treatment, and Dr. Futten, then the third

will be a guest speaker, Dr. Samra Hose, talking about tele capturing and vascular neurosurgery

And for the sake of time, I'll turn over to

the head honcho for SI and SI digital, and then we'll, after Jim talks, we'll turn over to Professor Caba. Well, thank God. I don't have much to say except welcome. Nice to see everybody and

let's try to thank you for all the work you put in on this. And let's hear from Professor Caba about intraoperative ultrasound. Anywhere you are seen as professors and colleagues And

I'm Cabullo. I'm going to talk about the neurosis and psychosis.

I'm a consultant neurosurgeon trained in Zimbabwe, right now practicing in

the

I will share one case money and I will tell you about our experience. So these are worms in the brain. So

parasites are organisms that exist by exploiting a host, by appearing nutrients from it. We have different types of parasites, we have protozoa, airmen, ectoparasides So a number of these

parasites can invade the central nervous system. despite the protection provided by the blood brain area. And CCCOCIS is the most common parasitic infection involving the central nervous system.

And in some low income countries, it's the most common cause of acquired epilepsy in adult.

It is caused by CCCOCIS cellulosia. This is a lava stage of the tapewem tenia soil, which has marked breath motion for nutrient control. As you can see, if you have the lava page, and you can see

it's heads, cold, connects. It has different parts. It has four circles, and it has also two rows of the

whole place on

the house. Excuse Dr. Cabo, let me just interrupt for a second. If I could have everybody mute the microphone, 'cause we're getting quite a bit of background noise.

Thank you so much, like I was saying, in some countries, like in Africa, in South America, southern Asian countries, you see on the table, on the picture show the area in red, it is showing

where the disease is endemic. And the incidence of neurosis ecosystem may reach 4 in some areas. And the infection is very long. Sometimes it can go up to more than a decade for you to see symptoms

from the moment you are infected The

rate of neurosis ecosystem are variable ranging from

12 people for every 100, 000

in countries like India.

The neurosis psychosis are variable due to differences in the diagnosis

capabilities and other causes related to the resources available. Especially in low and middle income countries, the

diagnosis poses a very big problem Let me go into a background, an historical background, from the time of ancient cultures intestinal parasite were identified as web. And the lava stage of the

postion type web, Tylia called Tylia solum, it has been recognized in P for more than two million These systems, hypocrite, Aristotle, Frastas, they denominated them as flat ones, initially. I

think probably from Aristotle's Historia animal.

a limalon due to their resemblance to a temp or to a band. That's why they were calling them flat band. Then, services and plenty and colleagues, they called them

Leungricas lattas, which means white women. And the dialects from the species of temp women was described initially by Vila Mufani with a temp that reflected the equivocal idea That one individual

could only carry one of these parasites. And later on in 1683,

Tizen describes the head of Ternat Sholem, like I mentioned before. After he saw the picture of the skull x of the parasite, then he described those suckers, as you can see. I mentioned that you

can see four suckers and two rows of hooklets then in 1855.

Kuch and Maestar identified the relationship between the ingestion of the Sissi Saka and the development of tinesis.

Then, other people described the Siss in the Copa Scallosa, as well

as Mr. Waton, who identified multiple cysts in adipose tissue and muscle, thinking they were glands, though they were not glands, they were cysts of Sissi Saka's And the evidence of this endemic

life and its interaction with specific communities was clearly established in Dixon's study, where he found infestation of British soldiers five years after they stayed in India. And currently, the

International Consensus defines the niacis as the

infestation in the

intestines and this is a process. like the infestation in other organs, like the brain, like the muscle. The life cycle of tiny solar and the natural issue is more complex, because usually people

confuse how we get infested, it goes into three stages, the lava, the embryo, and the adult women. So what is happening? You might get infected by two ways The first way is when we eat under

cooked pork meat. So where they are, the

worm, which is consistent in the meat. So when you eat it, it will go into the intestines and grow as an adult worm. Then you get the niacis. But the second way of doing it is by eating,

by drinking water, which is infested, by eating, uh, like, uh. food which is not washed well washed so when you eat the eggs which are because the worm is it has several parts those parts could

problem with this they get ends when you eat the eggs the eggs will go into the stomach then from the stomach they shall get melt then the labs are liberated then they can go into the

into the circulation then from there they can join the brain they can join the muscles they can join different organs like the hearts the eye and so on so these are organs which can be if infested by

the the lab like muscle you see this which were described last time like all glands but it was it was the

assist of the the the lava then into the heart, into the muscle, into the eye, and also into the brain, you can find those lavas. So it goes into stages. These stages, they are like evolution

of the disease. So when you get even into on the CT scan, you get different stages. The vesicular stage, this picture on the left shows the vesicular stage which correspond to the cysts that have

achieved immense tolerance This is a very world-defined cyst, which contains a dot inside. It's the head of the lava or the disk collapse. And at this stage, you have mild. You might or not have

edema, perilisional edema. Then the second stage is the colloidal stage, which correspond to the beginning of initial host response. When you get the host response, then you start to get the

perilisional edema.

The stage is the granular nodular stage, which represent feather damage to the cyst, where the fluid content within the cyst are no longer disabled on imaging. So this stage, you see

inside, you won't see the collects, and the fluid inside start to finish. And the last stage is the calcific stage, where you are only seeing calcifications in the brain on imaging And it's better

to see it on a on a CT scan, because classification sometimes on a MRI scan you won't see it properly. So the type of neurologic involvement, you can get spinal cord involvement, you can also get

giant cyst within the brain, which can go up to more than 50 millimeters And those cyst which are being developed in the brain, they are of two types. The first one is called the cyst, the cyst,

the cell in the zia. You see the regular ranging from 2 to 3 to 20 millimeters and the around or over. They tend to form in the parenchima and in

the narrow Sabarachnoid space. They contain these collects instead of the other cyst, which is called cysticecus racemosas, which are very large

And they grow actively in the buzz of arachnoid. And they produce that inflammation. So in this type of cyst, you won't see the lava inside the cyst. We can we find them. We have different

locations, meningia, where you can get in the docile lateral Sabarachnoid space. Usually it's the cysticecus racemoside. You can get them in the buzz of Sabarachnoid space you can get them into

the parent chima in 30 to 63. They can go also into the ventricle, especially when they're in the ventricle, they block the CSF flow and you might get hydrocephalus, or you can get the mixed

lesions and also the spinal lesions, which are very, very rare and sometimes they don't respond to treatment The clinical presentations depend on the number of lesions, depend on number of the

location of the deceased, and like I said the incubation period can go up to 30 years for you to develop symptoms What presenting symptoms

is seizures, you get patient, adult onset seizure with signs of elevated intracranial pressure, sometimes you get neurological deficit when the deceased is big and causing mass effect, and

sometimes out at mental status.

your nerve pulses when the cysts are in the baza in the arachnoid space causing baza arachnoiditis and sometimes in

the subcutaneous tissue you might get other cysts. So the day visit of this manifestation depending mainly on the size like I said the number the location of parasite and focal signs are frequently

due to local irritation or mass effect. In terms of clinical topographical presentation when they are in the parenchyma you will get cyjas when they in the meninges you might get chemical meningitis

into the ventricle you you can get

hydrocephalus and so on.

So what is happening when you are sending now the the simple to the laboratory? Sometimes you

get in the blood smear you get a bit different or it was in inferior. Sometimes CSF are normal. You collect and you send to the lab, they say it's normal. Proteins might be elevated or sometimes

normal. And glucose levels, sometimes they are normal. But

what you have to request is to look for over into this tool and the way you might get them in 33 So the

usual finding is the mononuclear pleocytosis, which sometimes another of 300 cells by cubic millimeters. Serology, unfortunately, sometimes in our center, like when you go in a rural area, you

won't get this. You do enzyme-linked immunoelectrotransfered blood And AIBT,

which is -

effectively supersede a laser. And the weight data is considered significantly at 164 in serum and 18 in CSF. So first negative result can also be found. What else we do, radiographic? You do

x-ray of muscles. You can do x-ray of ties. Then you will see calcification into the muscles. You can do scow x-ray, which is going to show you calcifications into the brain from the x-ray. And

on CT scan, like I mentioned, there are different stages, physical stage, nodular stage, nodular glandular stage, and the calcific stage. On MRI, like I mentioned, you see the cysts with

perilisional edema, which is high-paintance on

T2. Cosification sometimes are very difficult to see on MRI because the certifications are.

IO intense on T1 and IO intense on T2. On spectroscopy,

you might see a peak of lactate, acetate, alanine and succinate. But the presence of strong succinate with a smaller acetate peak may help to differentiate neurosis psychosis from pyogenic brain

abscess. And also, if you check you are doing your spectroscopy, you go into the cyst, you might not find coline and

acetate aspartid But it can help you to differentiate an acrotic area of a brain abscess from neurosis psychosis when you are doing a spectroscopy. Because when you get a tumor with an acrotic area,

you get a peak of lactate and lipid, which are not seen in neurosis psychosis. According to the agnostic criteria, in some developing countries,

people Ah,

oh. confusing this with the tuberculosis, because sometimes imaging can be the same, but now the best way to understand the clinical spectrum of neurosis psychosis has been true diagnostic criteria,

which are based on four elements, epidemiological data, immunological, radiological and clinical. There are these two associations, American Society of Tropical Medicine and I gene, and

infectious diseases, Society of America, which gives us these criteria to diagnose neurosis psychosis. They are absolute criteria, major criteria, minor criteria and epidemiologic criteria. What

we have to do if it's definitive neurosis psychosis, you get one absolute criteria or two major criteria or one major and two minor plus one epidemiologic If you get the combination of those. you

can think about the neurosis stochosis.

Then we

might differentiate it from tuberculosis, from brain abscess, cystic tumors with the inside the brain and sometimes to idiotic cysts. What are the treatment, what we are doing, what we are using

locally here in our country? We give anti-meltic medication, anti-epileptics drugs, steroid and surgery. And this surgery, you might do surgery section of the deceased or the lesion, or you can

do a CSF diversion. Siroi, they are very, very important because when you are about to start medical treatment, you have to give steroid first, to reduce the amount of edema otherwise the patient

will deteriorate while you are giving anti-meltic drug. And in our setting, what we are doing within Siroi, we start with dexamethasone, eight milligrams,

Then on day three, we decrease the dose to four milligrams, eight hourly, and on day six, we change now, dexamethasone to prednisolone. And at that moment, we introduce now our anti-apoleptic

drugs. So anti-apoleptic, they respond very well. Usually it's one only, you won't even go to

two drugs, you give one, and usually they respond well And the risk for seizures is when you get classified brain lesions, when the patient is presenting with multiple seizures, and when you get

multiple brain cysts

How are you? Do you want to

introduce you to the weeks from Mexico? What did you say briefly, Dr. Arredondo has been introduced to us as one of the shining and bright figures in Mexican neurosurgery. He's in Guadalajara and

with that introduction, I mean, he came highly recommended by all my senior colleagues from the country. So Dr. Arredondo, you

continue with your opinions about this

subject of sister causes on this engineering system. Thank

you

very much, Dr. Lasereve. Can you hear me, everyone, can you hear me? Yes. Yes, perfect Thank you for the kind introduction. Sister cases in Mexico are in many other development countries.

It's a major problem and still it's a health services of public problem. And we have a major incidence of this disease

in the last five years, which has been decreased from the first years of the 90s. We have in 1996, for example,

about

1600 cases per year. And in the last register in 2022, we have

225 cases. So we are seeing a diminished in the cases

in our country. And the major problem is, of course, the lack of

preventive measures

in the preparation of the food and the prevalence of the street food in Mexico. So you noticed a decrease in the incidence? What do you attribute that to? I think there is a

major information and more education among the population. And I think it's because people are preparing best their food and they are aware of being in risk of being

with to acquire the disease if

they don't have the measures to take care of the food.

How do these people present to neurosurgery with seizures or mass effect?

Most of them present with seizures, but some cases are present with mass lesions

and the most prevalent form of sister coaches is the parenthesis, these are coaches. And we have seen

every day

less cases of hydrocephalus associated with this disease. Hello, professor. I'm sorry my network was bad. Can you hear me? Yes, we're just hearing from Louise about his experience in Mexico and

actually your slides at the right time because I was going to ask Louise and now that you're back, Cabullo, what are

the drugs you used to treat them and how successful are they?

I'm almost at the end. Please can I proceed? Professor? OK, thank you so much. So I think we use risaconta, 50 millibrams per kg, and we divide it into three doses. The most used is

albendazole, 15 milligrams per kg per day. Then we divide into two to three days. But we have to start first with the

steroid first before we introduce this one. Then how do we prevent them? It measures sanitary education, which is the most important strategy to control this disease And hand washing, also

installation of latrins or other hygienic measures for disposal of human waste. And in the surgery, the surgery may be used to establish the diagnosis. You can do the biopsy, to get the definition

of the diagnosis. You can do stereotactic biopsy, which is well suited for small lesions And CSF, the invasion, you do ventricular veritoneal shunt to treat hydrocephalus. Sager also might be

indicated for spinal cyst,

intraventricular cyst, which may be less responsible to medical therapy. When you get intraventricular, that's why people sometimes they do it endoscopically to go and remove the cyst into the

ventricular, otherwise you get hydrocephalus. And the spinal cyst, once it grows, it will compress, you

get the

neurological deficit related to that And surgery may also be used for giant cysts, when intratina eye potential does not respond to steroid. But though every case you are operating, you have to

continue. After the surgery, you have to continue with anti-automatic drugs to complete the treatment. And follow up, we always do CT scan every six months until the lesions disappear completely

into the brain I will show you a 46 year old male who.

was diagnosed with neuropsychosis and he went at the local facility. You see the picture here. This is the vesicular stage. You can see the lesions with a white dot inside. This is the skull.

This patient went somewhere and he received albendazole without giving steroid. The patient deteriorated. The Glasgow Comaskill dropped up to nine on 15. So he could not walk. He could not talk

for two years. Then this patient was referred to us. The moment the patient came to us, we did a CT scan control. This was the CT scan. It was now the calcified stage. You see only

calcifications you can see into the brainpower and chima with active hydrocephalus. Then we shunted this patient after something a month later, the patient could walk and could pronounce view it.

Today we are almost four months was the CSM division and we are planning to do a CT scan. Though it's a very poor patient who could not even do a CT scan control soon after the, the, the, the,

the, the, the, the,

I think we just lost him again, but it was a very, very good talk,

Professor Kubolo. Luis, any more comments? What do you just saw? I

have a question for Dr. I don't remember the name. The

name? The Kabbalah. Kabbalah. Dr. Kabbalah, excuse me. I'll be connected. I think he got disconnected. Yeah. Okay I was wondering how many shunt failures they have in their practice or

because the failure of the shunt in my country is very high

because of this disease. So we need to do a revision of the shunt failure more than two or three times because of the I don't know. What is the amount of revision of the shunt in this country? Is

that because of protein in the sun, shunt?

That's the main cause of the protein in the CSF. And it's not related mainly to the technique, but it's related, yes, to the protein content.

Are these shunt's, commercial shunt's, or do you have shunt's in Mexico that you make in Mexico that you use, or are they straight to

oops? No, most of the

shunt's come from South America. We don't have

shunt's made in our country. In the past years, we have

shunt's made in Mexico, but it's no more available, those shunt's

which with President Quinto and our Bend as well. What's the expectation for the reduction of the CSF protein content?

We need to expect at least

one or two weeks to the proteins to decrease in the CSF, but sometimes we need to put a shunt very early and we have a very high index of failure in the shunt. Right. Thank you.

Well, we just got the hand of Dr. Kabbalah. It was a wonderful presentation,

Dr. Kabbalah. So as a neurosurgeon, do you see hydrocephalus is the most common? Do you see a large cyst is the most common? Do you see what your experience in Mexico and then Kabbalah can tell

us And what do you see in the Democratic Republic of the Congo?

The perincomal presentation is must come on. We personally, I have not made a surgery in the past one year related to neurocystic psychosis, which resembles

the degrees of the incidence of the disease. But

mostly of the presentation, which is our perincomal. And fortunately, not related to hydrocephalus, because

the percentage of failure insurance is very high.

There's a question in the chat about the option of external ventricular drainage before placing in a permanent shunt. Yes, we use that. Yes. Yeah.

That's right, Alvin wanted to ask your question. Alvin has your, Alvin, please go ahead. You have your hand raised. Thank you, thank you, professors. So Dr. Cabolo, thanks for that

beautiful presentation. But I just want to know what is the rationale of changing, changing the steroids. You started with dexamethasone, and then you say after, I think after some of the two

hours, and then you gave pregnancy lung Is there any - I don't know. I just need to know what is the rationale. Why can't I also continue with just one? You know dexamethasone?

Why should it be changed to another steroids? Thank you so much. Beautiful presentation. Anybody answer the question about changing steroids?

It's from a high dose to a low dose I guess what I got out of that, but. Anybody in the audience have experience with that? I think Dr. Gabula, I think Dr. Doug was indicating that there was a

change of the steroid type. It looked to me like they wanted to prevent steroid dependence

but Jorge, do you know anything about that? No, no, I would imagine that

the patient dictates the dose and the opportunity, you know? But I don't know, but I don't have any deep knowledge about that, no, but I don't know. I think it may be because the prednisolone of

prednisone in our countries is more, more available in oral presentation and dexamethasone is in intravenous presentation. I think that's the origin of the change

Just you have any experience.

in Cameroon with us or Sam and go ahead Ignatius, yeah.

Thank you, Dr. Cabullo. That was a very excellent presentation. I actually work in the northern part of Cameroon and is majority Muslims. So for the past four years, I've just had two cases

of neuroses and cystic fibrosis. And we actually even wrote a case report about a lady who was initially a Christian, and she used to eat pork And then later, converted to become a Muslim. But

when we found an used to neurocystic psychosis, in this case, we're a bit embarrassed, you know? So we don't have much experience with that. I've just had two cases of our four years. And this

way, in Japan, camera cases, the patient presented with seizures, in bandages, seizures, and then with, and they have meaty drugs and the patient recovered without any problems.

Sam, do you see this in Nigeria?

Thank you very much, Andrew.

Nigeria, strangely enough, we eat a lot of pork in Nigeria. And this is quite, it's not a common in Nigeria, but I have not encountered one neurosurgical case over the so many years of practicing

Nigeria. It's a bit strange. Maybe we're a musician. We have one of the domestic tools to be able to make a diagnosis, but I can't recall that we have treated it in my center

Okay, Dr. Grossman, did you mind if I add that? If we're hearing our neurosurgery conference at UCLA from time to time, that the patients who had the cystic psychosis, we had last year one from

the spinal cord, they removed it completely without a rupture. And also we see, personally, I see many patients who migrated from Mexico to Los Angeles They come with seizures and you're on the

anti-epileptic because of the cystic psychosis. Unfortunately, this is the topic that is very insisted on neurosurgery and they try to teach it especially the medication the doctor presented is the

one that she's used and also it was a beautiful, beautiful presentation of this because this is the topic I used to teach with Dr. Jorge Lazarov in the class for the students just to make them aware

and your talk was excellent and really I appreciate and we see that in Los Angeles we see it especially the county hospital we have the cases from time to time and they know it very well and they

handle it beautifully because of the cases that we see. Thank you very much. Mariela from Cuba, did you see this in Cuba at all by Mariela?

No in Cuba it's very impregnative. I've never seen after you'll be formed. I never didn't give you the neurotypical. Okay, but it looks like

Ignatius, our name or Professor Cabullo, that it's concentrated in different areas of Africa. Is that true?

Yes, as I mentioned before, I work in the majority Muslim community. When I asked Cabullo what's in Lumumbashi and I think it's a mixed community with the majority of Christians. So Christians,

epoch, and Muslims don't. So, for example, during my training, I was in Cairo, I didn't, over 70 years, I didn't see a case of neuro-centrificosis in Cambodia, I've seen too. So I think

that's experienced why Cabullo maybe has seen so many cases whereas we have seen very few

Okay, I just wanted to indicate that he invited Dr. O'Kimmler to

Yeah, Dr. Kimo, please do. Yeah, Dr. Kimo couldn't make it.

Dr. Kimo couldn't make it. He's our neuropathologist, but we rarely see neurocystic psychosis in Kenya. Of all the years I've worked, we haven't done a, I never did a single surgery. Dr. Kibwe,

I think is on this call. If Dr. Kibwe is now working at Ganesha National Hospital, or it could give us his comments, but.

Yeah, Dr. Kibwe.

All right, thank you, thank you so much, yeah. It's true, we don't see a lot of

patients with sclerosis in our set up, but that was a very good presentation. Really showcasing what we have. What we see in our country is more of a high that exists. The high that is common in a

notable part of our country And the professor, you are very much aware about our identity system.

but that very good presentation and thank you very much. Okay. Thank you. Yeah.

I could comment. I mean, it was a, it was a wonderful presentation and very, very informative because I really don't know when a fast, last revised neurocystic psychosis was a, as I said, we

rarely really see it. Hydrated disease is very common in our, in our setup. Now, in our population, we have a, although the Muslim population is about 10

majority is Christians, but still we don't see neurocystic psychosis. I have discussed this with our physicians as to whether maybe they treat the condition, but even the physicians and

neurophysicians, they don't, they don't see it. So I think this is one area we really would like to do, to go a step forward. up this with my colleagues in DRC to find out how come they see these

cases and we don't see them. What's the epidemiological factor? What is the reason, you know, we like because they hygienic factors, the exposure factors at the same. So if that was there, we

should be seeing these cases. So I really don't know why we don't see them. And this is why I wanted our neuropathologists to come and give me these views. But we do see cysticicosis. We see

cysticicosis. It's a common problem in our country, but we don't see neurocysticicosis.

Thanks. Dr. Resarata, if you're trying

to reach in the hand. We should probably go on to Dr. Kava's presentation. But let's hear from Dr. King, who has his hands raised. And there are questions in the chat, so if people can answer

in the chat, that would be great.

You're mute.

You can hear me now? Yes. Yeah, I just had a comment. One that Dr. Kupuda's talk was outstanding. And I, out of times that I've traveled Africa, I've not seen psychosis, but. in And

psychosis cystic with patients 10 about treated I've, America I think that we got to be aware, and our residents have to be aware of

this problem because we have so many immigrants. And we can't forget about cystic psychosis 'cause it's alive and well. And so I think that we have to keep that in our differential when treating

patients, especially immigrants from all over the world. Excellent, Paul.

Sayed? Yes, Doctor, I wanted to mention that in South of Iran, which is a Muslim country, We have a lot of hydrostatic. And as everybody knows, the animal involved is the dog, is the warmth,

the present grows in the intestine of the dog. And because of their excrement in the area, the people who get contaminated, and it goes, then the treatment is totally different. And we had some

talks from the, our colleague from Iraq, who had a lot of case like that. So it's a contrast, those who are in the Muslim world If the dogs are in contaminated, hydrolysis is very prevalent. And

sometimes it's very deadly. And those we have the work using cystic circuses. And in the talk we had at UCLA, they have never seen hydrolysis, at least at UCLA, as up to now. Because the animals

or the quarantine before coming to US and Canada. But there have been some cases from East Europe, who have immigrated. through Canada, four cases, they were contaminated with the hydro thesis.

Thank you. Thank you, Alia. Dr. Cabolo, you raised your hand and then we had to move on, I guess. But first of all, it's just a wonderful talk. Very nicely done, very informative. You wanna

make some comments? Thank you so much, Professor. I'm very sorry about my network, very sorry for that. I wanted to answer the question about changing theory When we give dexamethasone, it's

injection. Then imagine someone who comes with neuropsychosis with no surgical indication. And you can't keep the patient for 10 days in the hospital while you're receiving steroid. Imagine

dexamethasone, the tablets here, they are 05 milligrams. If you want to give eight milligrams, it means the patient has to take 16 or more than that tablet, it wants. So if you go to

dexamethasone to prednisolone to be few tablets, then you discharge your patient. The patient continues the medication at home with the arbendazone instead of keeping the patient with dexamethasone

for long and injection and long period for oral or for injection of dexamethasone only in the hospital. That's the reason why we change We change it because with brednisolone you take less pews than

dexamethasone. Thank you so much. Yeah, thanks. Thanks for that clarification. Excellent. Kubula, one other question. Why do you see it more commonly in your country as opposed to others? Do

you know?

Yes, we see neurosis and those we are operating, they are less than those we are treating medically Even recently, we gave a tablet to one of our colleagues, Doctor. who had the neurosis

psychosis, but with no hydrocephalus. He came already in the pacified stage

and we gave a tablet and everything went well. So we see more of these cases. Like I can say, for four years, I have more than 30 cases of neurosis psychosis. So the presentation I would guess to

neurosurgeons is perincomal from seizures, maybe acutely from hydrocephalus. And the

drug treatments, are they very successful or not?

Yes, many of them they come with seizures. Adult onset seizure, when you do CT scan, you get

the diagnosis. And adults, when they've started somewhere, You know, neurosurgery is still a young discipline in my country. So sometimes patients are being kept somewhat where they are giving

treatment like malaria and whatever. When they send, of course, we are operating the arrives already with signs of rest intracranial pressure. You receive them already with hydrocephalus, then

you shunt them.

Just to note before we go on to Dr. Kaba, it's turning out that Ivermectin, which wasn't mentioned here, but it's a commonly used for parasitic disease, and a bend as though I turn out to be

very effective anti-cancer agents, and people are working on that and finding that so, they're very cheap, very effective, and very powerful, and very safe.

Estrada, you wanna ask

Dr. Kaba to go on with this presentation?

I think you're muted. I think Dr. Kaba is ready, so please proceed. Thank you, it looks like he's getting started. Thanks.

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Surgical Neurology International is read in 239 countries and territories. It's the third largest neurosurgery journal in readership since 2010.

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This is also supported by the Medical News Network, which is dedicated to bringing truthful medical and science

This program is supported by the James I. and Carolyn, our Osmond Educational Foundation,

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A Review of Cysticercosis; Dr. Katanga Kabulo from DRC in Africa

SNI Digital®, the Global, Interactive, Peer-reviewed, New Video Journal of Neurosurgery and Neuroscience-2024 Edition; "Innovations in Learning" for the 21st century

VIDEO EDITORIAL

NEW SNI Digital® Version 4.2

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A Review of Cysticercosis; Dr. Katanga Kabulo from DRC in Africa

SNI Digital®, the Global, Interactive, Peer-reviewed, New Video Journal of Neurosurgery and Neuroscience-2024 Edition; "Innovations in Learning" for the 21st century VIDEO EDITORIAL

NEW SNI Digital® Version 4.2

SNI Digital®, the Global, Interactive, Peer-reviewed, New Video Journal of Neurosurgery and Neuroscience-2024 Edition; "Innovations in Learning" for the 21st century

VIDEO EDITORIAL