Quadriparalytic disseminated neurocysticercosis

Isolated Intramedullary Lumbar Spine Neurocysticercosis: A Rare Occurrence and Review of Literature

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.

Systematic Review and Meta-Analysis of Management Strategies and Outcomes in Adult Spinal Neurocysticercosis

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.