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LETTER TO THE EDITOR
Year : 2017  |  Volume : 12  |  Issue : 4  |  Page : 399-400
 

Hippocampal sclerosis in a child with multiple neurocysticercosis


Paediatrics and Child Health, Consultant Paediatrician, Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq

Date of Web Publication26-Mar-2018

Correspondence Address:
Mahmood Dhahir Al-Mendalawi
P. O. Box 55302, Baghdad Post Office, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JPN.JPN_103_17

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   Abstract 




How to cite this article:
Al-Mendalawi MD. Hippocampal sclerosis in a child with multiple neurocysticercosis. J Pediatr Neurosci 2017;12:399-400

How to cite this URL:
Al-Mendalawi MD. Hippocampal sclerosis in a child with multiple neurocysticercosis. J Pediatr Neurosci [serial online] 2017 [cited 2020 Feb 26];12:399-400. Available from: http://www.pediatricneurosciences.com/text.asp?2017/12/4/399/227961


Sir,

I have three comments on the interesting case report by Aulakh on hippocampal sclerosis (HS) in a 7-year-old Indian child with multiple neurocysticercosis (NCC).[1]

First, the author mentioned that magnetic resonance imaging showed that “the anterior head part of the right hippocampus appeared smaller as compared to the left side suggestive of HS.”[1] I presume that such a suggestion on HS needs to be confirmed by quantitative analysis of the hippocampus using volumetry. To my knowledge, normative volumetric data of the hippocampi for the Indian pediatric population between 6 and 12 years of age were constructed more than a decade ago. The mean right hippocampal volume (HV) was estimated to be 2.75cm3 and mean left HV to be 2.49cm3. The mean HV was measured to be 2.67cm3 (SD = 0.42). The upper and lower limits for HV were 3.51 and 1.83cm3, respectively, based on 95% (± 2SD) limits on either side of the mean. There was no effect of age or gender on the HV.[2] From a practical viewpoint, HV ≤ 1.83cm3 (≤2SD) was considered to be abnormal in the clinical setting.[2] I wonder why the author did not refer to the above-mentioned Indian normative data to firmly diagnose HS.

Second, the author mentioned that the child had continued to remain seizure-free during the follow-up period of 1.5 years despite evident right HS.[1] This point is really interesting as it contradicts with the antecedent observation reported by a set of Indian researchers pointing out that NCC patients with HS had more frequent clustering of seizures and extratemporal/bitemporal interictal epileptiform discharges as compared to patients with HS alone.[3]

Third, the author mentioned that “follow-up neuroimaging studies have revealed the development of HS 2 years after the diagnosis of NCC lends support to the hypothesis that NCC can be a causative factor in the development of HS and potential mechanism seems to be inflammation-mediated and not recurrent seizures.”[1] Actually, four plausible mechanisms underlying the pathophysiology combining NCC and HS have been suggested from studying a series of Indian patients with NCC-associated HS. These include the following: seizures due to NCC might constitute the initial precipitating illness for the HS development; the hippocampus might be involved in host brain inflammation and gliosis in response to a nearby degenerating cysticercus; the seizure focus formed by the degenerating cysticercus engenders epileptogenic changes in the hippocampus through kindling; and, finally, the two conditions might coexist purely by chance.[4]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Aulakh R. Hippocampal sclerosis in a child with multiple neurocysticercosis. J Pediatr Neurosci 2017;12:112.  Back to cited text no. 1
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2.
Mulani SJ, Kothare SV, Patkar DP. Magnetic resonance volumetric analysis of hippocampi in children in the age group of 6-to-12 years: a pilot study. Neuroradiology 2005;47:552-7.  Back to cited text no. 2
[PUBMED]    
3.
Rathore C, Thomas B, Kesavadas C, Radhakrishnan K. Calcified neurocysticercosis lesions and hippocampal sclerosis: potential dual pathology? Epilepsia 2012;53:e60-2.  Back to cited text no. 3
[PUBMED]    
4.
Singla M, Singh P, Kaushal S, Bansal R, Singh G. Hippocampal sclerosis in association with neurocysticercosis. Epileptic Disord 2007;9:292-9.  Back to cited text no. 4
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