1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Xu Y, Zhang Y, Luo Y, Qiu G, Liu Y, Zhao W, Wang Y. Thoracic ossification of the ligamentum flavum causing Brown-Séquard syndrome: a case report and literature review. J Int Med Res 2022; 50:3000605221110069. [PMID: 35903859 PMCID: PMC9340934 DOI: 10.1177/03000605221110069] [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] [Indexed: 12/02/2022] Open
Abstract
Brown-Séquard syndrome (BSS) has many etiologies, including penetrating trauma, extramedullary tumors, and disc herniation. However, thoracic ossification of the ligamentum flavum (OLF) is an extremely rare cause of this syndrome. A 46-year-old woman with motor weakness in her right lower extremity and urinary retention was admitted to our department. Based on the results of physical examination, computed tomography, and magnetic resonance imaging, a diagnosis of BSS with OLF was considered. The patient underwent urgent conservative treatment. BSS is a rare condition characterized by hemisection or hemicompression of the spinal marrow. The herein-described case of incomplete BSS due to OLF responded to conservative treatment. However, the successful nonoperative management of this case is insufficient evidence to consider it as the standard of care. Therefore, emergency laminectomy decompression remains the standard of care for BSS.
Collapse
Affiliation(s)
- Yeqiu Xu
- Department of Orthopedic Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, Hangzhou, P.R. China.,Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, P.R. China
| | - Yuanzhuang Zhang
- Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, P.R. China
| | - Yinzhou Luo
- Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, P.R. China
| | - Guanzhen Qiu
- Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, P.R. China
| | - Yize Liu
- Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, P.R. China
| | - Wei Zhao
- Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, P.R. China
| | - Yong Wang
- Department of Orthopedic Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, Hangzhou, P.R. China.,Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, P.R. China
| |
Collapse
|
3
|
Intramedullary parasite eggs, latent for three decades, mimicking acute transverse myelitis. BMC Infect Dis 2022; 22:9. [PMID: 34983433 PMCID: PMC8725547 DOI: 10.1186/s12879-021-07013-7] [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: 02/16/2021] [Accepted: 12/23/2021] [Indexed: 12/02/2022] Open
Abstract
Background Intramedullary parasitic infection is extremely uncommon, and clinical presentation of Brown-Sequard syndrome is even rarer. Case presentation The authors report a case involving a 57-year-old woman with Brown-Sequard syndrome, in whom magnetic resonance imaging and clinical and epidemiological features were similar to those of acute transverse myelitis. Myelotomy suggested inflammation caused by latent parasite eggs in the spinal cord. Antiparasitic and steroid therapies were administered postoperatively. To the author’s knowledge, this is the first report to describe a surgical experience for Taenia solium eggs in the spinal cord. Conclusion Intramedullary parasitic infection is a diagnostic challenge that requires careful discrimination from other diseases. If parasite infection is suspected in a progressively deteriorating patient, myelotomy should be considered for rapid and accurate treatment.
Collapse
|
4
|
Dhar A, Dua S, Singh H. Isolated Intramedullary Lumbar Spine Neurocysticercosis: A Rare Occurrence and Review of Literature. Surg J (N Y) 2021; 7:e327-e336. [PMID: 34926816 PMCID: PMC8674092 DOI: 10.1055/s-0041-1739118] [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: 06/07/2021] [Accepted: 09/23/2021] [Indexed: 10/26/2022] Open
Abstract
Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system. Spinal cysticercosis is a rather rare clinical occurrence. Intramedullary (IM) spinal NCC is rarer still. Furthermore, cases of IM-NCC at lumbar levels are few and far between. We present a case of a 35-year-old male patient who was diagnosed to have IM-NCC at L2-3 level and was managed surgically with no recurrence at 2 years of follow-up. A systematic literature review (1992-2020) highlights it to be only the third case reported with exclusive lumbar involvement.
Collapse
Affiliation(s)
- Anil Dhar
- Department of Neurosurgery, Max Super Speciality Hospital, New Delhi, India
| | - Sanjeev Dua
- Department of Neurosurgery, Max Super Speciality Hospital, New Delhi, India
| | - Hershdeep Singh
- Department of Neurosurgery, Max Super Speciality Hospital, New Delhi, India
| |
Collapse
|
5
|
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.
Collapse
|
6
|
Yu Y, Jin Z, Ma H, Chen F. Spinal intramedullary cysticercosis with syringomyelia: a case report. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:2593-2598. [PMID: 33165438 PMCID: PMC7642718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/26/2020] [Indexed: 06/11/2023]
Abstract
Intramedullary cysticercosis of the cervical spine is extraordinarily rare; prior reports are limited to single cases. We review cases of intramedullary cysticercosis, and summarize the features and outcome. Herein, we report a 38 year old woman with progressive quadriplegia, paresthesia in bilateral upper limbs, neck pain and headache for 1 month. She had dyspnea for 1 week. A gross total resection was performed, and after the surgery, the patient was given prednisolone per day orally, for 2 weeks. Oral albendazole 400 mg/day was started 2 days after the start of prednisolone. Ag-ELISA was performed 2 months after the completion of treatment and no residual lesion was seen. At the 6-month postsurgical follow-up, no recurrence of the cysticercosis was noted. Cysticercosis of the cervical spine is extraordinarily rare. Preoperative identification of intramedullary cysticercosis is challenging, and the exact diagnosis depends on histopathological evidence and Ag-ELISA. With symptoms of the nervous system, surgical resection should be performed in time.
Collapse
Affiliation(s)
- Ying Yu
- Department of Neurosurgery, The First Hospital of Jilin UniversityChangchun, China
| | - Zheng Jin
- Department of Neurosurgery, The First Hospital of Jilin UniversityChangchun, China
| | - Hanyun Ma
- Chairté Comprehensive Cancer Center, Charité University HopspitalBerlin, Germany
| | - Fan Chen
- Department of Neurosurgery, The First Hospital of Jilin UniversityChangchun, China
| |
Collapse
|
7
|
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.
Collapse
|
8
|
Barrie U, Badejo O, Aoun SG, Adeyemo E, Moler N, Christian ZK, Caruso JP, El Ahmadieh TY, Ban VS, MacAllister MC, Reyes VP, Hall K, Whitworth L, Bagley CA. Systematic Review and Meta-Analysis of Management Strategies and Outcomes in Adult Spinal Neurocysticercosis. World Neurosurg 2020; 138:504-511.e8. [PMID: 32224269 DOI: 10.1016/j.wneu.2020.03.093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Spinal involvement in neurocysticercosis is rare and can lead to debilitating injury if not diagnosed and treated early. We aim to provide the reader with a thorough analysis of the best available evidence regarding patient characteristics, optimal treatment modality, and outcomes in cases of spinal neurocysticercosis. METHODS A systematic review of the literature using PubMed, Google Scholar, and Web of Science electronic databases was made according to the PRISMA guidelines. An illustrative case of intramedullary-cervical spinal disease is also presented for illustrative purposes. RESULTS A total of 46 reports of 103 patients fitting the screening criteria were identified. Isolated spinal involvement was seen in 46.15% of patients. Most infections (76.92%) had an intradural extramedullary localization, with 43.27% of cases involving >1 spinal cord level. The most common presenting symptoms were motor deficits (77.88%), pain syndromes (64.42%), and sensory deficits (53.85%). Combined surgical resection and pharmacologic therapy was the most frequently used treatment modality (49.04%) and had the highest proportion of patients reporting symptomatic improvement at follow-up (78.43%). Combination therapy had a significantly higher rate of neurologic recovery compared with surgery alone (P = 0.004) or medical treatment (P = 0.035). CONCLUSIONS Spinal involvement in neurocysticercosis should be considered in patients from or who traveled to endemic areas presenting with ring-enhancing lesions. Combined treatment with surgery followed by cysticidal and steroid medication seems to be superior to surgery or medical treatment in isolation and seems to provide the highest chances of recovery.
Collapse
Affiliation(s)
- Umaru Barrie
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Olatunde Badejo
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Emmanuel Adeyemo
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nicole Moler
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Zachary K Christian
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - James P Caruso
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Vin Shen Ban
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Matthew C MacAllister
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Valery Peinado Reyes
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kristen Hall
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Louis Whitworth
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Carlos A Bagley
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
9
|
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.
Collapse
Affiliation(s)
| | | | - Dominic Shelby Cervantes
- Department of Neurosurgery, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico
| | | |
Collapse
|
10
|
Muralidharan V, Nair BR, Patel B, Rajshekhar V. Primary Intradural Extramedullary Cervical Spinal Cysticercosis. World Neurosurg 2017; 106:1052.e5-1052.e11. [PMID: 28711534 DOI: 10.1016/j.wneu.2017.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/01/2017] [Accepted: 07/05/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Spinal cysticercosis has been reported in 0.7%-3.0% of patients with neurocysticercosis. Most patients with spinal cysticercosis have a coexisting intracranial disease. Most often this intracranial disease manifests as intradural extramedullary lesions involving thoracic and lumbar regions or intramedullary lesions. Intradural extramedullary primary spinal cysticercosis manifesting as cervical myelopathy is extremely rare and has not been reported to date. CASE DESCRIPTION A 56-year-old man from the northeastern part of India presented with progressive spastic quadriparesis. Magnetic resonance imaging showed a ventrally located intradural extramedullary multiloculated cyst with an enhancing wall in the upper cervical region. Enzyme-linked immunoelectrotransfer blot performed to detect cysticercal antibodies in serum was positive. The patient underwent total excision of the cysts, which were confirmed histologically to be cysticercal cysts. He was also treated with 2 weeks of albendazole therapy after surgery. He had recovered fully 1 year later. CONCLUSIONS Cysticercosis should be considered in the differential diagnosis in a patient with multiloculated cysts in the spinal subarachnoid space. Surgical exploration and excision of the cysts should be performed not only to establish a diagnosis but also to decompress the cord before medical therapy.
Collapse
Affiliation(s)
| | | | - Bimal Patel
- Department of Pathology, Christian Medical College, Vellore, India
| | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College, Vellore, India.
| |
Collapse
|
11
|
Acquired Spinal Arteriovenous Fistula Presenting as Brown-Séquard Syndrome and Endovascular Treatment Outcome. World Neurosurg 2016; 96:613.e1-613.e4. [PMID: 27593715 DOI: 10.1016/j.wneu.2016.08.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Brown-Séquard syndrome is typically caused by penetrating trauma to the cervical spinal cord; however, other compressive and vascular occlusive etiologies have been previously described. It is extremely uncommon to have a delayed presentation as an extramedullary compressive lesion from the venous varix of an acquired spinal arteriovenous fistula. CASE DESCRIPTION We present a case of a patient in the fifth decade of life, with a remote history of gunshot wound to the left thorax with progressive left-sided weakness and contralateral pain and temperature sensory loss secondary to cord compression from an acquired spinal arteriovenous fistula. CONCLUSIONS Subsequent treatment occurred with coil embolization with good outcome.
Collapse
|