Intramedullary spinal neurocysticercosis presenting as brown-sequard syndrome

Intramedullary parasite eggs, latent for three decades, mimicking acute transverse myelitis

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.

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.

Spinal intramedullary cysticercosis with syringomyelia: a case report

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.

Spinal racemose cysticercosis: case report and review

Cysticercosis is a common helminthic infection worldwide, endemic in Central and South America, sub-Saharan Africa, and Southeast Asia. Neurocysticercosis typically involves brain parenchyma, subarachnoid space, and the ventricular system. Although the spinal cord is frequently involved in patients with parenchymal neurocysticercosis, isolated spinal involvement is rare, occurring in only 1-3% of patients. We report a case of racemose spinal neurocysticercosis with brain parenchyma involvement in a 49-year-old Mexican man, who presented with unsteady gait and bilateral arm numbness and weakness. Magnetic resonance imaging revealed multiseptated cystic lesions in the upper cervical spinal canal and nonenhancing intradural extramedullary cystic lesions in the thoracic spine. The patient underwent sub-occipital craniectomy with decompression, followed by a course of steroids and albendazole. Pathology confirmed the diagnosis of neurocysticercosis, and the patient's symptoms resolved after treatment. We include discussion on the symptoms, diagnosis, and treatment of neurocysticercosis with a focus on the spinal form.

Intramedullary spinal cord neurocysticercosis presenting as Brown-Séquard syndrome

Background

Cysticercosis is a parasitic disease caused by the larval stage of Taenia Solium. Involvement of the central nervous system by this tapeworm is endemic in developing countries. However, isolated spinal involvement by Taenia Solium is uncommon and having clinical presentation of Brown-Séquard syndrome is even rarer.

Case presentation

A 43-year-old male who came to the emergency department with clinical presentation of complete Brown-Séquard syndrome. Computed tomography scan of the brain was normal. Magnetic resonance imaging of the thoracic spine revealed an intramedullary mass of the spinal cord at C-7/T-l level. Patient underwent surgery that revealed a cystic lesion and was resected. Histopathological report confirmed the diagnosis of neurocysticercosis. Postoperatively, oral steroid therapy and a four week course of albendazol were administered.

Conclusions

Intramedullary neurcysticercosis represents a diagnostic challenge and should be considered in intramedullary lesions in settings where Taenia solium is endemic. Clinical, pathophysiological and diagnostic aspects of spinal cord intramedullary neurocysticercosis are discussed.