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Table of Contents    
LETTER TO EDITOR
Year : 2011  |  Volume : 59  |  Issue : 6  |  Page : 922-923

Cysticercosis of filum terminale


1 Department of Pathology, Silver Oaks Hospital, Mohali, Punjab, India
2 Department of Neurosurgery, Silver Oaks Hospital, Mohali, Punjab; Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission09-Aug-2011
Date of Decision09-Aug-2011
Date of Acceptance28-Sep-2011
Date of Web Publication2-Jan-2012

Correspondence Address:
Bharti Ahuja
Department of Pathology, Silver Oaks Hospital, Mohali, Punjab
India
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DOI: 10.4103/0028-3886.91388

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How to cite this article:
Ahuja B, Banerjee AK, Kak V K. Cysticercosis of filum terminale. Neurol India 2011;59:922-3

How to cite this URL:
Ahuja B, Banerjee AK, Kak V K. Cysticercosis of filum terminale. Neurol India [serial online] 2011 [cited 2014 Apr 19];59:922-3. Available from: http://www.neurologyindia.com/text.asp?2011/59/6/922/91388


Sir,

Neurocysticercosis (NCC) typically involves the brain parenchyma, intracranial subarachnoid space or ventricular system. Spinal NCC, even in endemic regions, is rare. [1] We report a case of cysticercosis of filum terminale masquerading as a spinal tumour.

A 39-year-old vegetarian female, presented with episodic right lower limb pain of two months' duration. Neurological examination was essentially normal. Contrast-enhanced magnetic resonance imaging (CE-MRI) of the lumbosacral spine revealed an enhancing intradural extramedullary lesion at the L4 vertebral level [Figure 1]. She underwent L3-L4 laminectomy. At operation a cystic lesion lying in the subarachnoid space at the L3 level was easily picked up and removed. There was a firm intradural lesion adherent to the nerve roots which was also excised. Intraoperative clinical diagnosis was intradural schwannoma. On gross examination, the cyst was 0.5 ml in volume and the mass measured 2.5 cm × 1.4 cm × 0.5 cm in size. Microscopic examination of the cystic lesion revealed structure consistent with body cavity of cysticercus larva. The mass attached to the nerve showed inflammatory tissue with foci of necrosis and stellate abcesses [Figure 2]. Enzyme-linked immunosorbent assay (ELISA) for cysticercus antibodies was performed postoperatively, which was positive (2.1). Screening MRI of brain and rest of the spinal cord were also normal. She was put on cysticidal therapy and steroids, albendazole 400 mg/day and methylprednisolone 8 mg/day for one month.
Figure 1: MRI showing a hypointense lesion (arrow) at the L3 level, and an enhancing 'mass' at the L4 level

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Figure 2: (a) The parasite; (b) Inflammatory mass in the spinal subarachnoid space; a spinal nerve (*) is seen at the periphery; (c) The centre of the inflammatory mass showing necrosis and inflammatory cells [Hematoxylin and eosin, ×100]

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Spinal cysticercosis is an uncommon entity. Spinal cord involvement is reported in 1.2-5.8% of patients with NCC. [2] Intramedullary NCC is far less common than extramedullary leptomeningeal disease. [2],[3] MRI is the investigation of choice for the diagnosis. On MRI the lesions show a hypointense rim with hyperintense core on T2-weighted, and hypointense or isointense lesion on T1-weighted imaging. [4] However, these are not specific and the same changes can also be present in neoplastic, inflammatory, demyelinating, vascular and other granulomatous diseases. In our case also, the initial MRI diagnosis was a tumor. The entire neuraxis should be screened to find additional lesions. Filum terminale cysticercosis has not been described in the literature so far. Given its rarity and absence of typical features, the diagnosis of spinal neurocysticercosis was made only by the identification of larva by histopathological examination.

 
  References Top

1.Gupta S, Singh PK, Gupta B, Singh V, Azam A. Isolated primary intradural extramedullary spinal neurocysticercosis: A case report and review of literature. Acta Neurol Taiwan 2009;18:187-92.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.De Souza Queiroz L, Filho AP, Callegaro D, De Faria LL. Intramedullary cysticercosis: Case report, literature review and comments on pathogenesis. J Neurol Sci 1975;26:61-70.  Back to cited text no. 2
[PUBMED]    
3.Sharma BS, Banerjee AK, Kak VK. Intramedullary spinal cysticercosis: Case report and review of literature. Clin Neurol Neurosurg 1987;89:111-6.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Mathuriya SN, Khosla VK, Vashishta RK, Tewari MK, Pathak A, Prabhakar S. Intramedullary cysticercosis: MRI diagnosis. Neurol India 2001;49:71-4.  Back to cited text no. 4
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