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Fletcher AM, Bhattacharyya S. Infectious Myelopathies. Continuum (Minneap Minn) 2024; 30:133-159. [PMID: 38330476 DOI: 10.1212/con.0000000000001393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Infectious myelopathy of any stage and etiology carries the potential for significant morbidity and mortality. This article details the clinical presentation, risk factors, and key diagnostic components of infectious myelopathies with the goal of improving the recognition of these disorders and guiding subsequent management. LATEST DEVELOPMENTS Despite our era of advanced multimodal imaging and laboratory diagnostic technology, a causative organism often remains unidentified in suspected infectious and parainfectious myelopathy cases. To improve diagnostic capability, newer technologies such as metagenomics are being harnessed to develop diagnostic assays with a greater breadth of data from each specimen and improvements in infection identification. Conventional assays have been optimized for improved sensitivity and specificity. ESSENTIAL POINTS Prompt recognition and treatment of infectious myelopathy decreases morbidity and mortality. The key diagnostic tools include serologies, CSF analysis, and imaging; however clinical presentation, epidemiologic risk factors, and history of recent illness are all vital to making the proper diagnosis because current laboratory and imaging modalities are often inconclusive. The cornerstone of recommended treatment is targeted antimicrobials with appropriate immune modulation, surgical intervention, supportive care, and interdisciplinary involvement, all of which further improve outcomes for patients with infectious myelopathy.
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Wang G, Shen H, Chu Z, Shen J, Zhu KC. Benign cervical intramedullary cyst without an epithelial lining:a case report. Br J Neurosurg 2023; 37:1664-1666. [PMID: 34009086 DOI: 10.1080/02688697.2021.1927983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
This paper presents a female, benign intramedullary cyst case aged 66-year-old. During the operation, it was found that the cystic wall was very thin, and the cystic fluid was colorless and transparent. The lesion with the capsule was removed partially. Surprisingly, there was no epithelial lining on the capsule wall. It is very rare and different from the benign intramedullary cysts reported in the literature.
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Affiliation(s)
- GengHuan Wang
- Neurosurgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - HePing Shen
- Neurology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - ZhengMin Chu
- Neurosurgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - JianGuo Shen
- Neurosurgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Kun Can Zhu
- Neurosurgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
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Tao B, Li T, Ji K, Shang A. Spinal nerve root sleeve cysticercosis: a case report and review of the literature. J Med Case Rep 2023; 17:80. [PMID: 36814326 PMCID: PMC9945364 DOI: 10.1186/s13256-022-03733-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 12/21/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Neurocysticercosis is a parasitic infection of the central nervous system by tapeworm larvae. Spinal cysticercosis is thought to be relatively rare, and spinal nerve root sleeve cysticercosis have not been reported previously. CASE PRESENTATION A 46-year-old Chinese Han female patient presented with low back pain and radicular pain of the right lower limb. The visual analog scale was 6. Magnetic resonance imaging showed a subarachnoid cyst at the S1 level, with a slight enhanced rim. The patient underwent surgical treatment. During surgery, we found the cyst located mainly in the subarachnoid space and partly in a sacral nerve root sleeve. Cysticercosis was also confirmed by postoperative pathological examination. Postoperative drug therapy was performed after cysticercosis was confirmed. Postoperatively, the patient was treated with oral albendazole (15 mg/kg) for 1 month. Only mild sensory impairment was left when she was discharged. After 3 years of follow-up, the visual analog scale reduced from 6 to 2, and the patient's sensory function completely recovered. Magnetic resonance imaging showed no recurrence of cysticercosis. CONCLUSION Subarachnoid cysticercosis may extend to nerve root sleeve causing back pain and radiculopathy, which may present with similar magnetic resonance imaging manifestations to Tarlov cysts. Hence, spinal subarachnoid cysticercosis should be considered as an important differential diagnosis of arachnoid cyst and sacral Tarlov cyst. Combined treatment with surgical removal and drug therapy is effective to manage spinal subarachnoid cysticercosis.
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Affiliation(s)
- Benzhang Tao
- grid.414252.40000 0004 1761 8894Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China ,grid.265021.20000 0000 9792 1228Tianjin Medical University, Tianjin, China
| | - Teng Li
- grid.414252.40000 0004 1761 8894Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China
| | - Kaipeng Ji
- Department of Neurosurgery, Jin Cheng Da Hospital, Jincheng, Shanxi China
| | - Aijia Shang
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Human Neurocysticercosis: An Overview. Pathogens 2022; 11:pathogens11101212. [PMID: 36297269 PMCID: PMC9607454 DOI: 10.3390/pathogens11101212] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/20/2022] Open
Abstract
Human cysticercosis is caused by ingestion of T. solium eggs from taenia carriers. Neurocysticercosis (NCC), defined as the infection of the CNS and the meninges by the larval stage of Taenia solium, is the most common helminthic infection of the CNS worldwide. Parasites may lodge in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing pathological changes that account for the pleomorphism of this disease. Seizures/epilepsy are the most common clinical manifestation, but other patients present with headache, focal deficits, intracranial hypertension, or cognitive decline. Accurate diagnosis of NCC is possible after interpretation of clinical data together with findings of neuroimaging studies and results of immunological tests. However, neuroimaging studies are fundamental for diagnosis because immunological test and clinical manifestations only provide circumstantial evidence of NCC. The introduction of cysticidal drugs changed the prognosis of most NCC patients. These drugs have been shown to reduce the burden of infection and to improve the clinical course of the disease in many patients. Efforts should be directed to eradicate the disease through the implementation of control programs against all the steps in the life cycle of T. solium, including carriers of the adult tapeworm, infected pigs, and eggs in the environment.
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Neurocysticercosis in the Tropics (and Beyond). CURRENT TROPICAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40475-022-00269-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yang C, Liu T, Wu J, Xie J, Yu T, Jia W, Yang J, Xu Y. Spinal cysticercosis: a rare cause of myelopathy. BMC Neurol 2022; 22:63. [PMID: 35193508 PMCID: PMC8862344 DOI: 10.1186/s12883-022-02589-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background Neurocysticercosis is a neuroinfectious disease caused by the larval stage of the tapeworm Taenia solium. Isolated spinal cysticercosis is rare, with limited cases having been reported in the literature. This entity poses great diagnostic and therapeutic challenges. Methods This retrospective study included seven patients pathologically diagnosed with spinal cysticercosis. The clinical manifestations, radiological features on magnetic resonance imaging (MRI), treatment, and outcomes were analyzed. Results This case series consisted of four male and three female patients, with an average age of 34.9 ± 10.9 years. Clinically, six patients manifested with localization-related myelopathy. There were four solid lesions, one cystic-solid lesion, and three cystic lesions. The solid and cystic-solid lesions showed characteristic MRI features: 1) within the lesion, there was a mural nodule with isointensity on T1WI and iso- to hyperintensity on T2WI; 2) the signals at the periphery of the mural nodule were variable, ranging from hypointense to hyperintense on T2WI; and 3) ring-like or cyst wall enhancement could be present, and dot-like enhancement could be noted in the mural nodule. Complete resection of the responsible lesion was achieved in all patients, and oral albendazole was administered in a patient with one more suspected homologous lesion. After a mean follow-up period of 56.7 ± 35.1 months, the patient’s symptoms mostly regressed. Conclusion Spinal cysticercosis is an extremely rare cause of myelopathy. Characteristic MRI features can facilitate preoperative diagnosis. Clinicians should be aware of this entity, and it should be included in the differential diagnosis of myelopathy.
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Affiliation(s)
- Chenlong Yang
- Department of Neurosurgery, Peking University Third Hospital, Haidian District, Beijing, China.,North America Medical Education Foundation, Union, CA, USA
| | - Tie Liu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Wu
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jingcheng Xie
- Department of Neurosurgery, Peking University Third Hospital, Haidian District, Beijing, China
| | - Tao Yu
- Department of Neurosurgery, Peking University Third Hospital, Haidian District, Beijing, China
| | - Wenqing Jia
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun Yang
- Department of Neurosurgery, Peking University Third Hospital, Haidian District, Beijing, China.
| | - Yulun Xu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Abstract
PURPOSE OF REVIEW The patient who presents with an acute spinal cord syndrome with weakness/paralysis of the limbs presents a diagnostic. Two important syndromes are acute transverse myelitis (ATM) and acute flaccid paralysis (AFP). Both can be caused by a number of infectious and noninfectious causes. Since 2014 there have been outbreaks of acute flaccid myelitis (a subgroup of AFP) in the United States, with a national surveillance program underway. In addition, there have been increasing reports of ATM from new and emerging pathogens, and opportunistic infections in immunocompromised hosts. RECENT FINDINGS Infectious causes of ATM or AFP need to be ruled out first. There may be important clues to an infectious cause from epidemiologic risk factors, immune status, international travel, MRI, and laboratory findings. We summarize key features for the more common pathogens in this review. Advances in laboratory testing have improved the diagnostic yield from cerebrospinal fluid, including real-time polymerase chain reaction, metagenomic next-generation sequencing, and advanced antibody detection techniques. These tests still have limitations and require clinical correlation. SUMMARY We present a syndromic approach to infectious myelopathies, focusing on clinical patterns that help narrow the diagnostic possibilities.
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Majmundar N, Patel PD, Dodson V, Tran A, Goldstein I, Assina R. Parasitic infections of the spine: case series and review of the literature. Neurosurg Focus 2020; 46:E12. [PMID: 30611161 DOI: 10.3171/2018.10.focus18472] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/26/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVEAlthough parasitic infections are endemic to parts of the developing world and are more common in areas with developing economies and poor sanitary conditions, rare cases may occur in developed regions of the world.METHODSArticles eligible for the authors' literature review were initially searched using PubMed with the phrases "parasitic infections" and "spine." After the authors developed a list of parasites associated with spinal cord infections from the initial search, they expanded it to include individual diagnoses, using search terms including "neurocysticercosis," "schistosomiasis," "echinococcosis," and "toxoplasmosis."RESULTSTwo recent cases of parasitic spinal infections from the authors' institution are included.CONCLUSIONSKey findings on imaging modalities, laboratory studies suggestive of parasitic infection, and most importantly a thorough patient history are required to correctly diagnose parasitic spinal infections.
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9
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Del Brutto OH. Current approaches to cysticidal drug therapy for neurocysticercosis. Expert Rev Anti Infect Ther 2020; 18:789-798. [DOI: 10.1080/14787210.2020.1761332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Oscar H. Del Brutto
- School of Medicine, Universidad Espíritu Santo, Ecuador, Samborondón, Ecuador
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10
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White AC, Coyle CM, Rajshekhar V, Singh G, Hauser WA, Mohanty A, Garcia HH, Nash TE. 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 2019; 66:e49-e75. [PMID: 29481580 DOI: 10.1093/cid/cix1084] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/19/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Hector H Garcia
- Instituto Nacional de Ciencias Neurologicas and Universidad Peruana Cayetano Heredia, Lima, Peru
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11
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Abstract
Infectious diseases are an important cause of spinal cord dysfunction. Infectious myelopathies are of growing concern given increasing global travel and migration and expanding prevention and treatment with vaccinations, antibiotics, and antiretrovirals. Clinicians must recognize these pathologies because outcomes can dramatically improve with prompt diagnosis and management. We provide a complete review of the most frequent infectious agents that can affect the spinal cord. For each pathogen we describe epidemiology, pathophysiology, anatomic location, characteristic clinical syndromes, diagnostic approach, treatment, and prognosis. The review includes spinal imaging from selected cases.
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Affiliation(s)
- Mayra Montalvo
- Department of Neurology, Brown University, Rhode Island Hospital, 222 Richmond Street, Providence, RI 02903, USA
| | - Tracey A Cho
- Department of Neurology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242, USA.
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12
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Torres-Corzo JG, Islas-Aguilar MA, Cervantes DS, Chalita-Williams JC. The Role of Flexible Neuroendoscopy in Spinal Neurocysticercosis: Technical Note and Report of 3 Cases. World Neurosurg 2019; 130:77-83. [PMID: 31279105 DOI: 10.1016/j.wneu.2019.06.194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/24/2019] [Accepted: 06/24/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Neurocysticercosis, caused by the larval form of the tapeworm Taenia solium, is the most common parasitic disease affecting the human central nervous system. The incidence of spinal neurocysticercosis in endemic regions ranges from 0.25% to 5.85%. Surgery is preferred when medical treatment fails to achieve control of the symptoms or when multiple cysts are present. METHODS We describe the use of spinal flexible endoscopy for patients with spinal neurocysticercosis who failed to achieve control with standard treatment. Three patients with limb weakness and pain underwent a midline interspinous approach at the L5-S1 level to access the lumbar cistern. The flexible endoscope was introduced, the subarachnoid space was inspected, and the cysticerci were extracted. In 1 patient with cervical subarachnoid blockage, a 3-cm suboccipital craniotomy and removal of the posterior arch of C1 were performed to place a subarachnoid-to-subarachnoid catheter going from the craniocervical junction to the thoracic region. RESULTS Removal of the cysticerci was possible in all cases. No complications related to the surgery were observed. All patients received medical treatment for 2-3 months, and all symptoms were solved. CONCLUSIONS Flexible spinal endoscopy is a feasible and valuable tool in patients with spinal neurocysticercosis that do not respond adequately to standard treatment. It helps restore cerebrospinal fluid dynamics and can be used to place shunt catheters under guided vision. Longer endoscopes are needed to explore the entire spinal subarachnoid space with a single approach, and more research in this area is needed.
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Affiliation(s)
| | | | - Dominic Shelby Cervantes
- Department of Neurosurgery, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico
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13
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White AC, Coyle CM, Rajshekhar V, Singh G, Hauser WA, Mohanty A, Garcia HH, Nash TE. 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). Am J Trop Med Hyg 2018; 98:945-966. [PMID: 29644966 PMCID: PMC5928844 DOI: 10.4269/ajtmh.18-88751] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
| | | | | | | | | | - Aaron Mohanty
- University of Texas Medical Branch, Galveston, Texas
| | - Hector H Garcia
- Universidad Peruana Cayetano Heredia, Lima, Peru
- Instituto Nacional de Ciencias Neurologicas, Lima, Peru
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Yadav K, Garg D, Kaushik JS, Vaswani ND, Dubey R, Agarwal S. Intramedullary Neurocysticercosis Successfully Treated with Medical Therapy. Indian J Pediatr 2017; 84:725-726. [PMID: 28466406 DOI: 10.1007/s12098-017-2353-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Kuldeep Yadav
- Department of Pediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
| | - Deepali Garg
- Department of Pediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
| | - Jaya Shankar Kaushik
- Department of Pediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India.
| | - N D Vaswani
- Department of Pediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
| | - Rachana Dubey
- Department of Pediatrics, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, 452001, India
| | - Shalini Agarwal
- Department of Radiodiagnosis, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
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Zammarchi L, Bonati M, Strohmeyer M, Albonico M, Requena-Méndez A, Bisoffi Z, Nicoletti A, García HH, Bartoloni A. Screening, diagnosis and management of human cysticercosis andTaenia soliumtaeniasis: technical recommendations by the COHEMI project study group. Trop Med Int Health 2017; 22:881-894. [DOI: 10.1111/tmi.12887] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Lorenzo Zammarchi
- Unità di Malattie Infettive; Università Degli Studi di Firenze; Florence Italy
- SOD Malattie Infettive e Tropicali; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - Maurizio Bonati
- Department of Public Health, IRCCS; Istituto di Ricerche Farmacologiche Mario Negri; Milan Italy
| | - Marianne Strohmeyer
- Unità di Malattie Infettive; Università Degli Studi di Firenze; Florence Italy
| | - Marco Albonico
- Centro per le Malattie Tropicali; Ospedale Classificato Equiparato “Sacro Cuore Don Calabria”; Verona Italy
| | - Ana Requena-Méndez
- Barcelona Institute for Global Health; Universitat de Barcelona; Barcelona Spain
| | - Zeno Bisoffi
- Centro per le Malattie Tropicali; Ospedale Classificato Equiparato “Sacro Cuore Don Calabria”; Verona Italy
| | | | - Hector H. García
- Cysticercosis Unit; Universidad Peruana Cayetano Heredia; Lima Peru
| | - Alessandro Bartoloni
- Unità di Malattie Infettive; Università Degli Studi di Firenze; Florence Italy
- SOD Malattie Infettive e Tropicali; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
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Zalewski NL, Morris PP, Weinshenker BG, Lucchinetti CF, Guo Y, Pittock SJ, Krecke KN, Kaufmann TJ, Wingerchuk DM, Kumar N, Flanagan EP. Ring-enhancing spinal cord lesions in neuromyelitis optica spectrum disorders. J Neurol Neurosurg Psychiatry 2017; 88:218-225. [PMID: 27913626 DOI: 10.1136/jnnp-2016-314738] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/27/2016] [Accepted: 11/16/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We assessed the frequency and characteristics of ring-enhancing spinal cord lesions in neuromyelitis optica spectrum disorder (NMOSD) myelitis and myelitis of other cause. METHODS We reviewed spinal cord MRIs for ring-enhancing lesions from 284 aquaporin-4 (AQP4)-IgG seropositive patients at Mayo Clinic from 1996 to 2014. Inclusion criteria were as follows: (1) AQP4-IgG seropositivity, (2) myelitis attack and (3) MRI spinal cord demonstrating ring-enhancement. We identified two groups of control patients with: (1) longitudinally extensive myelopathy of other cause (n=66) and (2) myelitis in the context of a concurrent or subsequent diagnosis of multiple sclerosis (MS) from a population-based cohort (n=30). RESULTS Ring-enhancement was detected in 50 of 156 (32%) myelitis episodes in 41 patients (83% single; 17% multiple attacks). Ring-enhancement was noted on sagittal and axial images in 36 of 43 (84%) ring enhancing myelitis episodes and extended a median of two vertebral segments (range, 1-12); in 21 of 48 (44%) ring enhancing myelitis episodes, the ring extended greater than or equal to three vertebrae. Ring-enhancement was accompanied by longitudinally extensive (greater than or equal to three vertebral segments) T2-hyperintensity in 44 of 50 (88%) ring enhancing myelitis episodes. One case of a spinal cord biopsy during ring-enhancing myelitis revealed tissue vacuolation and loss of AQP4 immunoreactivity with preserved axons. The clinical characteristics of ring-enhancing myelitis episodes did not differ from non-ring-enhancing episodes. Ring-enhancing spinal cord lesions were more common in NMOSD than other causes of longitudinally extensive myelopathy (50/156 (32%) vs 0/66 (0%); p≤0.001) but did not differ between NMOSD and MS (50/156 (32%) vs 6/30 (20%); p=0.20). CONCLUSIONS Spinal cord ring-enhancement accompanies one-third of NMOSD myelitis episodes and distinguishes NMOSD from other causes of longitudinally extensive myelopathies but not from MS.
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Affiliation(s)
| | | | | | | | - Yong Guo
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Laboratory Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Karl N Krecke
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Neeraj Kumar
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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17
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Bhardwaj N. Response to Letter to the Editor. J Emerg Med 2017; 52:104-105. [PMID: 27712902 DOI: 10.1016/j.jemermed.2016.07.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/19/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Nidhi Bhardwaj
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
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18
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Del Brutto OH, Nash TE, White AC, Rajshekhar V, Wilkins PP, Singh G, Vasquez CM, Salgado P, Gilman RH, Garcia HH. Revised diagnostic criteria for neurocysticercosis. J Neurol Sci 2016; 372:202-210. [PMID: 28017213 DOI: 10.1016/j.jns.2016.11.045] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/29/2016] [Accepted: 11/20/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND A unified set of criteria for neurocysticercosis (NCC) has helped to standardize its diagnosis in different settings. METHODS Cysticercosis experts were convened to update current diagnostic criteria for NCC according to two principles: neuroimaging studies are essential for diagnosis, and all other information provides indirect evidence favoring the diagnosis. Recent diagnostic advances were incorporated to this revised set. RESULTS This revised set is structured in absolute, neuroimaging and clinical/exposure criteria. Absolute criteria include: histological confirmation of parasites, evidence of subretinal cysts, and demonstration of the scolex within a cyst. Neuroimaging criteria are categorized as major (cystic lesions without scolex, enhancing lesions, multilobulated cysts, and calcifications), confirmative (resolution of cysts after cysticidal drug therapy, spontaneous resolution of single enhancing lesions, and migrating ventricular cysts on sequential neuroimaging studies) and minor (hydrocephalus and leptomeningeal enhancement). Clinical/exposure criteria include: detection of anticysticercal antibodies or cysticercal antigens by well-standardized tests, systemic cysticercosis, evidence of a household Taenia carrier, suggestive clinical manifestations, and residency in endemic areas. Besides patients having absolute criteria, definitive diagnosis can be made in those having two major neuroimaging criteria (or one major plus one confirmative criteria) plus exposure. For patients presenting with one major and one minor neuroimaging criteria plus exposure, definitive diagnosis of NCC requires the exclusion of confounding pathologies. Probable diagnosis is reserved for individuals presenting with one neuroimaging criteria plus strong evidence of exposure. CONCLUSIONS This revised set of diagnostic criteria provides simpler definitions and may facilitate its more uniform and widespread applicability in different scenarios.
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Affiliation(s)
- O H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador
| | - T E Nash
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD, United States
| | - A C White
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - V Rajshekhar
- Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India
| | - P P Wilkins
- Parasitology Services, Marathon, FL, United States
| | - G Singh
- Department of Neurology, Dayanand Medical College, Ludhiana, India
| | - C M Vasquez
- Department of Neurosurgery, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - P Salgado
- Neuroimaging Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico
| | - R H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - H H Garcia
- Center for Global Health, Tumbes, Peru; Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Peru; Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.
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Gonzales I, Rivera JT, Garcia HH. Pathogenesis of Taenia solium taeniasis and cysticercosis. Parasite Immunol 2016; 38:136-46. [PMID: 26824681 DOI: 10.1111/pim.12307] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/25/2016] [Indexed: 12/22/2022]
Abstract
Taenia solium infections (taeniasis/cysticercosis) are a major scourge to most developing countries. Neurocysticercosis, the infection of the human nervous system by the cystic larvae of this parasite, has a protean array of clinical manifestations varying from entirely asymptomatic infections to aggressive, lethal courses. The diversity of clinical manifestations reflects a series of contributing factors which include the number, size and location of the invading parasites, and particularly the inflammatory response of the host. This manuscript reviews the different presentations of T. solium infections in the human host with a focus on the mechanisms or processes responsible for their clinical expression.
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Affiliation(s)
- I Gonzales
- Cysticercosis Unit, Department of Transmissible Diseases, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - J T Rivera
- Department of Microbiology and Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - H H Garcia
- Cysticercosis Unit, Department of Transmissible Diseases, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.,Department of Microbiology and Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
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Minimally manipulative extraction of polycystic cervical neurocysticercosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:63-68. [PMID: 27613008 DOI: 10.1007/s00586-016-4763-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/14/2016] [Accepted: 08/27/2016] [Indexed: 10/21/2022]
Abstract
CLINICAL HISTORY Intradural, extramedullary cervical spinal involvement is an uncommon manifestation of neurocysticercosis. CASE REPORT A case of a middle-aged man with neurocysticercosis in the intradural extramedullary cervical spine and brain who originally presented with bilateral paresthesias of his extremities, with a progressively unsteady gait. Magnetic resonance imaging revealed cystic enhancing lesions in the brain and cervical region of the spine, with the largest cyst extending from the posterior fossa through C2, causing spinal cord compression. The patient underwent surgical resection of the intradural extramedullary cervical spinal lesions, and he has continued to improve clinically, with no recurrence of cystic lesions. CONCLUSION When examining patients with clinical signs of a spinal mass lesion, the differential diagnosis should include neurocysticercosis of the spine.
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Abstract
Predisposing factors for developing spinal infections include: immunodeficiency; drug abuse; the widespread use of broad-spectrum antibiotics, corticosteroids, and immunosuppressive drugs; diabetes mellitus; and spinal surgery. Infections can be bacterial, fungal, parasitic, or viral in origin. This chapter reviews current knowledge in clinical and imaging findings in the most common spinal infections divided according to the compartment primarily involved.
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Affiliation(s)
- Majda M Thurnher
- Department of Radiology, University Hospital Vienna, Vienna, Austria.
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Spinal Taenia solium cysticercosis in Mexican and Indian patients: a comparison of 30-year experience in two neurological referral centers and review of literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:1073-81. [PMID: 26474877 DOI: 10.1007/s00586-015-4271-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 09/30/2015] [Accepted: 09/30/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To present a retrospective study from patients with spinal cysticercosis (SC), diagnosed within the last 30 years in Mexican and Indian neurological referral centers. METHODS This is a retrospective and comparative study of the clinical and radiological profile between Mexican and Indian patients with spinal neurocysticercosis during a 30-year period and a review of the literature during the same period. RESULTS Twenty-seven SC patients were included: 19 from Mexico and 8 from India. SC presented predominantly with motor symptoms (21/27 patients): paraparesis and paraplegia were the most common signs; one-third of patients presented sphincter dysfunction. Imaging studies showed that parasites in vesicular stage were more frequent in patients from Mexico, while degenerative stages predominated in India. Association of subarachnoid cysticerci and hydrocephalus was observed only in Mexican patients. CONCLUSIONS Despite the limitations of this study, the collected information supports the existence of differences in the clinical and radiological traits of SC patients between Asian and Latin-American hospitals. The possible biological factors that may underlie these differences are discussed.
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Torous VF, Darras N. A lumbar canal cystic mass lesion in a man with a history of chronic lower back pain. Neuropathology 2015; 36:103-6. [PMID: 26177559 DOI: 10.1111/neup.12228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/31/2015] [Accepted: 04/30/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Vanda Farahmand Torous
- Beth Israel Deaconess Medical Center, Department of Pathology and Laboratory medicine, Boston, Massachusetts, United States
| | - Natasha Darras
- Beth Israel Deaconess Medical Center, Department of Pathology and Laboratory medicine, Boston, Massachusetts, United States
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Bhardwaj N. Spinal Intramedullary Cysticercosis: A Rare Diagnostic Dilemma. J Emerg Med 2015; 49:e79-80. [PMID: 26104845 DOI: 10.1016/j.jemermed.2014.12.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 10/17/2014] [Accepted: 12/22/2014] [Indexed: 11/28/2022]
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Sorte DE, Poretti A, Newsome SD, Boltshauser E, Huisman TAGM, Izbudak I. Longitudinally extensive myelopathy in children. Pediatr Radiol 2015; 45:244-57; quiz 241-3. [PMID: 25636706 DOI: 10.1007/s00247-014-3225-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 08/09/2014] [Accepted: 10/27/2014] [Indexed: 12/13/2022]
Abstract
When children present with acute myelopathy manifested by sensory, motor, or bowel and bladder symptoms, MRI of the neuraxis with contrast agent is the most important imaging study to obtain. Although occasionally normal, MRI often demonstrates signal abnormality within the spinal cord. Classically, longitudinally extensive transverse myelitis (≥3 vertebral bodies in length) has been described with neuromyelitis optica (NMO), but alternative diagnoses should be considered. This pictorial essay reviews the differential diagnoses that may present with longitudinally extensive spinal cord signal abnormalities. Multiple inflammatory, infectious, vascular, metabolic and neurodegenerative etiologies can present with a myelopathy. Thus, radiologists can assist in the diagnosis by familiarizing themselves with the spectrum of diseases in childhood that result in longitudinally extensive signal abnormalities in the absence of trauma.
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Affiliation(s)
- Danielle Eckart Sorte
- Division of Interventional Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Abstract
The infection of the nervous system by the cystic larvae of Taenia solium (neurocysticercosis) is a frequent cause of seizure disorders. Neurocysticercosis is endemic or presumed to be endemic in many low-income countries. The lifecycle of the worm and the clinical manifestations of neurocysticercosis are well established, and CT and MRI have substantially improved knowledge of the disease course. Improvements in immunodiagnosis have further advanced comprehension of the pathophysiology of this disease. This knowledge has led to individualised treatment approaches that account for the involvement of parenchymal or extraparenchymal spaces, the number and form of parasites, and the extent of degeneration and associated inflammation. Clinical investigations are focused on development of effective treatments and reduction of side-effects induced by treatment, such as seizures, hydrocephalus, infarcts, and neuroinjury.
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Affiliation(s)
- Hector H Garcia
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru; Centre for Global Health-Tumbes and Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Theodore E Nash
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador; Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador
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Abstract
Neurocysticercosis, the most common helminthic infection of the nervous system, is a major cause of acquired epilepsy worldwide. The disease occurs when humans become intermediate hosts of the tapeworm Taenia solium after ingesting its eggs by contagion from an asymptomatic Taenia carrier. Within the nervous system, parasites may locate in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing several pathological changes that are responsible for the clinical pleomorphism of the disease. Seizures are the most common clinical manifestation, but a sizable proportion of patients develop focal deficits, intracranial hypertension, or cognitive decline. Preoperative diagnosis of neurocysticercosis is possible after proper integration of data from neuroimaging studies and immunological tests. Cysticidal drugs (albendazole and praziquantel) have changed the prognosis of most patients with neurocysticercosis. The use of these drugs has shown to reduce the parasite load within the central nervous system and to improve the clinical prognosis of the disease in many cases. Future studies should focus on disease eradication through the implementation of control programs against all the interrelated steps in the life cycle of T solium, including human carriers of the adult tapeworm, infected pigs, and eggs in the environment.
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Affiliation(s)
- Oscar H. Del Brutto
- Department of Neurological Sciences, School of Medicine, Universidad Espíritu Santo–Ecuador, Hospital-Clínica Kennedy, Guayaquil, Ecuador
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Abstract
Cysticercosis in one of the most common parasitic infections in the central nervous system. The complex and unpredictable nature of the host immune reaction against cysticercosis as well as the pleomorphism of your injuries make the disease neurocysticercosis interesting and fascinating to study. Imaging studies play an important role in the diagnosis of this disease. Advanced imaging techniques have improved detection and visualization of scolex cysts extraparenchymal spaces.
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Affiliation(s)
- Rosa Delia Delgado Hernández
- From the *Radiology Department, Manuel Velasco Suarez National Institute of Neurology Neurosurgery, National Institute of Medical Science Nutrition Salvador Zubiran, Mexico City; †Mexican Academy of Surgery, Mérida, Yucatán; and ‡Neuroradiology Department and Teaching Division, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico
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Abstract
Neurocysticercosis is the most common helminthic disease of the nervous system and a leading cause of acquired epilepsy worldwide. Differences in the number and location of lesions as well as in the severity of the immune response against the parasites, makes neurocysticercosis a complex disease. Therefore, a single therapeutic approach is not expected to be useful in every patient. Introduction of cysticidal drugs - praziquantel and albendazole - have changed the prognosis of thousands of patients with neurocysticercosis. While pioneer trials of therapy were flawed by a poor design, recent studies have shown that cysticidal drugs results in disappearance of lesions and clinical improvement in most cases. Nevertheless, some patients with parenchymal neurocysticercosis may be left with remaining cysts and may develop recurrent seizures after therapy, and many patients with subarachnoid cysts may need repeated courses of therapy. In addition, not all forms of the disease benefit from cysticidal drugs.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espiritu Santo - Ecuador, Guayaquil, Ecuador
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Wiwanitkit V. Intramedullary Spinal Neuorocysticercosis. KOREAN JOURNAL OF SPINE 2014; 11:258. [PMID: 25620991 PMCID: PMC4303281 DOI: 10.14245/kjs.2014.11.4.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/30/2014] [Accepted: 12/02/2014] [Indexed: 11/19/2022]
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