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|Year : 2016 | Volume
| Issue : 1 | Page : 188-189
Isolated cervical intramedullary cysticercosis
Tushit Mewada, Arvind Kumar Srivastava
Department of Neurosurgery, GB Pant Institute of Post graduate Medical Education and Research, New Delhi, India
|Date of Web Publication||11-Jan-2016|
3/3, Old Rajender Nagar, Near Sanatan Dharm Mandir, Shankar Road, New Delhi - 110 060
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mewada T, Srivastava AK. Isolated cervical intramedullary cysticercosis. Neurol India 2016;64:188-9
Neurocysticercal infestation is the most common parasitic disease of the central nervous system. However, spinal involvement by neurocysticercosis is uncommon. We report a 43-year-old man with an intramedullary cysticercosis in the cervical spinal cord. This is the first report of a neurocysticercal cyst in the cervical spinal cord.
A 43-year-old male patient presented to us with weakness of the right upper limb and lower limb for 6 months. The weakness developed gradually affecting the upper limb first and then the lower limb. The grip in his right hand was less than that on the opposite side, and he had a spastic gait with increased spasticity mainly on the right side. The knee and ankle jerks were brisk in the right lower limb. MRI of the cervical spine revealed a well-defined intramedullary lesion at the C4–C5 level, which was hypointense on T1-weighted images; on T2 weighted images, there was a homogenously hyperintense cystic part and a small relatively hypointense part in the caudal region showing a solid component with cord expansion at the level [Figure 1]. No contrast enhancement was present. Surrounding cord changes were minimal. It was reported as an intramedullary mass at the C4–C5 level presumed to be a tumor (astrocytoma or ependymoma). Surgery was warranted for progressive neurological deterioration of the patient. Both C4 and C5 laminectomies were performed, and the underlying dura was opened. A brownish, translucent cyst was separated from the cord by hydrodissection and delivered in toto. The postoperative course was uneventful. The right upper and lower limb weakness improved. The patient also experienced a remarkable improvement in spasticity. He was subjected to full craniospinal-axis MRI evaluation, and no evidence of multiple site involvement was found [Figure 2]. Albendazole therapy (15 mg/kg/day) was administered in three cycles of a month's durations with an interspersed interval of a month between the cycles.
|Figure 1: Preoperative T1-weighted (left) and T2-weighted (right) MRI scans showing the intramedullary cysticercosis at the C4–C5-level|
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|Figure 2: Postoperative T1-weighted (left) and T2-weighted (right) MRI scans after removal of the C4–5 intramedullary cyst|
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The macroscopic examination revealed a cystic lesion measuring 2 × 1 × 0.8 cm, with a black nodule of 4-mm diameter. The cyst wall was thin, shiny, brownish, and translucent. Microscopic examination revealed a cysticercus cyst containing a protoscolex having an invaginated eosinophilic wavy layer (tegument) surrounded by a tegument cell layer in the loose connective tissue. The histological features were consistent with the diagnosis of neurocysticercosis [Figure 3].
|Figure 3: Microphotograph showing a cysticercus cyst containing a protoscolex having an invaginated eosinophilic wavy layer (tegument) surrounded by a tegument cell layer in the loose connective tissue|
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Spinal involvement occurs in only 0.7%–5.85% of patients due to much lesser (100 times) blood flow in the spine than in the brain., Four forms of spinal neurocysticercosis have been identified: Vertebral, extradural, intradural extramedullary, and intramedullary, the most common being that located in the intradural extramedullary region. Extramedullary forms occur because of CSF dissemination (ventriculo-ependymal migration) of the focus from the brain, whereas the intramedullary forms result from hematogenous spread of the parasitic larvae. Intramedullary cysticercosis is most frequently seen in the thoracic spine and occurs by hematogenous dissemination through the Artery of Adamkiewicz More Details. This is the first report of an isolated intramedullary cysticercosis in the cervical region.
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[Figure 1], [Figure 2], [Figure 3]