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SPINE IMAGE
Year : 2022  |  Volume : 9  |  Issue : 2  |  Page : 134-135

Cervical Intramedullary Cysticercosis


Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Submission05-Feb-2022
Date of Acceptance03-Mar-2022
Date of Web Publication31-May-2022

Correspondence Address:
Kamlesh Singh Bhaisora
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Barely Road, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joss.joss_7_22

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How to cite this article:
Kumar A, Bhaisora KS, Sasapardhi S, Srivastava AK. Cervical Intramedullary Cysticercosis. J Spinal Surg 2022;9:134-5

How to cite this URL:
Kumar A, Bhaisora KS, Sasapardhi S, Srivastava AK. Cervical Intramedullary Cysticercosis. J Spinal Surg [serial online] 2022 [cited 2022 Jul 7];9:134-5. Available from: http://www.jossworld.org/text.asp?2022/9/2/134/346366

A 49-year-old man, with no comorbidities, presented with complaints of gradually progressive spastic quadriparesis and paresthesia for 2 years. There were no bladder or bowel complaints. He did not complain of fever or past surgeries in recent past. On examination, the tone was increased in all four limbs (modified Ashworth scale grade 3). Power was 4/5 in all four limbs with bilateral grip weakness (right grip 10%–20% and left 70%–80%). There was a graded sensory loss to touch, temperature, and pain below C4, with impairment of the posterior column.

On MRI, there was a single, well-defined intramedullary lesion was seen at the C5-C6 vertebral body level. The lesion was T1 isointense to hypointense, T2 hyperintense, with patchy contrast enhancement (along the rim) [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d. A preoperative diagnosis of the cervical intramedullary tumor was made with a differential diagnosis of ependymoma, astrocytoma, or cavernoma.
Figure 1: A single intramedullary lesion, which was T1 hypointense (a), T2 hyperintense (b and d), and having minimal rim enhancement on contrast MRI (c), was seen on preoperative MRI. Intraoperatively, there was bulging of the cord at the site of lesion (e). myelotomy was done to expose the tumor (f). The lesion had a good plane with the cord parenchyma (g). It was completely excised (h)

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C5-C6 laminectomy was done and dura opened. The cord was bulging at the site of the lesion. Myelotomy was done to expose the lesion. It was grayish-white, moderately vascular, suckable, soft, with a well-defined plane between tumor and cord parenchyma. It was completely excised. The intraoperative impression was ependymoma [Figure 1]e, [Figure 1]f, [Figure 1]g, [Figure 1]h.

To our surprise, the histopathology sections showed the bladder wall of cysticercal cyst composed of double-layered eosinophilic membrane and underlying canalicular system. The fibrocollagenous wall with a mixed inflammatory infiltrate and necrotic material with calcification was also seen. These features confirmed it to be cysticercosis.

As a protocol for intramedullary tumors, injectable steroids were given to the patient till postoperative day three. He was later (on confirmation of pathology) started on tablet albendazole 15mg/kg/day for 6 weeks. Gradually, he recovered and is self-ambulatory at 1-year follow-up.

Intramedullary cysticercosis is a rare parasitic infection caused by Taenia solium, with less than 100 reported cases.[1] They are difficult to diagnose preoperatively due to rarity and nonspecific MRI features. The cystic lesion appears hypointense on T1WI with hyperintense scolex and hyperintense on T2WI. Peripheral ring enhancement is seen in the presence of cyst degeneration.[2] Due to intramedullary location, immunologic tests are also negative.[3] The present case comes in the “intraparenchymal single enhancing lesion due to neurocysticercosis” category as per the 2017 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Society of Tropical Medicine and Hygiene.[4] In such a case, they recommended albendazole (15 mg/kg/d in 2 daily doses up to 800 mg/d) for 1–2 weeks with concomitant corticosteroids. Most authors reported a favorable outcome with resection and antiparasitic therapy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gonçalves FG, Neves PO, Jovem CL, Caetano C, Maia LB. Chronic myelopathy associated to intramedullary cysticercosis. Spine (Phila Pa 1976) 2010;35:E159-62.  Back to cited text no. 1
    
2.
Mathuriya SN, Khosla VK, Vasishta RK, Tewari MK, Pathak A, Prabhakar S. Intramedullary cysticercosis: MRI diagnosis. Neurol India 2001;49:71-4.  Back to cited text no. 2
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3.
Lucato LT, Guedes MS, Sato JR, Bacheschi LA, Machado LR, Leite CC. The role of conventional MR imaging sequences in the evaluation of neurocysticercosis: Impact on characterization of the scolex and lesion burden. AJNR Am J Neuroradiol 2007;28:1501-4.  Back to cited text no. 3
    
4.
White AC Jr., Coyle CM, Rajshekhar V, Singh G, Hauser WA, Mohanty A, et al. Diagnosis and treatment of neurocysticercosis: 2017 Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis 2018;66:e49-75.  Back to cited text no. 4
    


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