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Andino D, Tsiang JT, Pecoraro NC, Jani R, Iordanou JC, Zakaria J, Borys E, Pasquale DD, Nockels RP, Schneck MJ. Case report and review of literature: Isolated intramedullary spinal neurocysticercosis. Front Neurol 2022; 13:1030468. [DOI: 10.3389/fneur.2022.1030468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/21/2022] [Indexed: 11/12/2022] Open
Abstract
BackgroundCases of isolated intramedullary spinal neurocysticercosis are extremely rare. Only 25 cases have been reported before 2022. Due to its rarity, the diagnosis of spinal neurocysticercosis may be missed.Case presentationWe describe a 37-year-old female patient who developed back pain and lower extremity weakness and was found to have an intramedullary thoracic spine cystic lesion. She was taken to the operating room for resection of the lesion. Pathology revealed a larval cyst wall consistent with neurocysticercosis. The patient was started on albendazole and dexamethasone. Her exam improved post-operatively, and she was able to ambulate with minimal difficulty at the time of follow up.ConclusionThe case provides insights on the diagnosis and treatment of isolated intramedullary spinal neurocysticercosis. Review of the literature suggests that combined surgical and medical intervention results in significant improvement in the patient's neurological exam, and decreases morbidity associated with the disease. We propose a treatment paradigm for this rare manifestation of neurocysticercosis.
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Zheng X, Wang F, Wang L, Li X, Li J, Huang M, Zou Y. A Rare Case of Cysticercosis Involving the Whole Spinal Canal. Acta Parasitol 2022; 67:569-572. [PMID: 34851512 PMCID: PMC8938355 DOI: 10.1007/s11686-021-00486-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cysticercosis is the commonest parasitic disease to affect the central nervous system (CNS). However, cysticercosis affecting the spine is extremely rare. We reported a rare case of cysticercosis involving the whole spinal canal in China. CASE PRESENTATION A rare case of cysticercosis involving the entire spinal cord, in a 52-year-old Chinese man, was detected in 2021. Epidemiological investigation, clinical and etiological examination was performed. CONCLUSION Since spinal cysticercosis is a rare but potentially life-threatening disease, clinicians should always consider the differential diagnosis of space-occupying lesions.
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Affiliation(s)
- Xiaoyan Zheng
- Emergency and Critical Care Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Tropical Medicine, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Beijing, China
| | - Fei Wang
- Emergency and Critical Care Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Tropical Medicine, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Beijing, China
| | - Lei Wang
- Emergency and Critical Care Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Tropical Medicine, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Beijing, China
| | - Xiaoli Li
- Emergency and Critical Care Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Tropical Medicine, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Beijing, China
| | - Jingjing Li
- Emergency and Critical Care Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Tropical Medicine, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Beijing, China
| | - Minjun Huang
- Emergency and Critical Care Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Tropical Medicine, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Beijing, China
| | - Yang Zou
- Emergency and Critical Care Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Tropical Medicine, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Beijing, China
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Yang C, Liu T, Wu J, Xie J, Yu T, Jia W, Yang J, Xu Y. Spinal cysticercosis: a rare cause of myelopathy. BMC Neurol 2022; 22:63. [PMID: 35193508 PMCID: PMC8862344 DOI: 10.1186/s12883-022-02589-2] [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: 12/29/2021] [Accepted: 02/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background Neurocysticercosis is a neuroinfectious disease caused by the larval stage of the tapeworm Taenia solium. Isolated spinal cysticercosis is rare, with limited cases having been reported in the literature. This entity poses great diagnostic and therapeutic challenges. Methods This retrospective study included seven patients pathologically diagnosed with spinal cysticercosis. The clinical manifestations, radiological features on magnetic resonance imaging (MRI), treatment, and outcomes were analyzed. Results This case series consisted of four male and three female patients, with an average age of 34.9 ± 10.9 years. Clinically, six patients manifested with localization-related myelopathy. There were four solid lesions, one cystic-solid lesion, and three cystic lesions. The solid and cystic-solid lesions showed characteristic MRI features: 1) within the lesion, there was a mural nodule with isointensity on T1WI and iso- to hyperintensity on T2WI; 2) the signals at the periphery of the mural nodule were variable, ranging from hypointense to hyperintense on T2WI; and 3) ring-like or cyst wall enhancement could be present, and dot-like enhancement could be noted in the mural nodule. Complete resection of the responsible lesion was achieved in all patients, and oral albendazole was administered in a patient with one more suspected homologous lesion. After a mean follow-up period of 56.7 ± 35.1 months, the patient’s symptoms mostly regressed. Conclusion Spinal cysticercosis is an extremely rare cause of myelopathy. Characteristic MRI features can facilitate preoperative diagnosis. Clinicians should be aware of this entity, and it should be included in the differential diagnosis of myelopathy.
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Affiliation(s)
- Chenlong Yang
- Department of Neurosurgery, Peking University Third Hospital, Haidian District, Beijing, China.,North America Medical Education Foundation, Union, CA, USA
| | - Tie Liu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Wu
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jingcheng Xie
- Department of Neurosurgery, Peking University Third Hospital, Haidian District, Beijing, China
| | - Tao Yu
- Department of Neurosurgery, Peking University Third Hospital, Haidian District, Beijing, China
| | - Wenqing Jia
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun Yang
- Department of Neurosurgery, Peking University Third Hospital, Haidian District, Beijing, China.
| | - Yulun Xu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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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.
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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
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Rajbhandari S, Gurung P, Yadav J, Rajbhandari P, Acharya S, Pant B. A case report of multiple isolated intradural neurocysticercosis of the lumbo-sacral spine. Int J Surg Case Rep 2021; 87:106434. [PMID: 34562721 PMCID: PMC8473764 DOI: 10.1016/j.ijscr.2021.106434] [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: 08/15/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Neurocysticercosis is the most common parasitic infection of the nervous system and it is mostly intracranial. Intradural intramedullary or extramedullary is the rarest involvement of intraspinal cysticercosis. Its isolated involvement is even rare, as it usually has intracranial association. We aim to report a rare case of isolated intraspinal neurocysticercosis and discuss the measures we can take for early management. Despite being an eradicable disease of public health importance, its prevalence is increasing widely in developed countries too. Therefore, we aim to discuss its pathogenesis, mode of spread, and preventive aspects as well. PRESENTATION OF CASE A 40-year-old woman presented to our hospital with pain over the lower back region radiating to the right thigh. Magnetic Resonance Imaging (MRI) of her lumbosacral spine revealed a cystic lesion at the spinal level L5-S1. We confirmed the diagnosis via Histopathological examination (HPE) following surgery. DISCUSSION Isolated intradural neurocysticercosis of the spine is extraordinarily rare involvement. It is caused by the larval stage of taenia solium. An MRI is the preferred imaging modality. Due to rarity and nonspecific clinic-radiological findings, diagnosis may often be missed. In our case, MRI revealed a cystic lesion at the L5-S1 level of the spine and multiple cystic lesions at the level were found intra-operatively. Its diagnosis is confirmed by HPE. Treatment can be medical or surgical according to the severity of the disease. CONCLUSION Although rare, neurocysticercosis can cause irreversible neurological damage. Therefore, surgeons should consider it in the differential diagnosis of intraspinal lesions.
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Affiliation(s)
| | - Pritam Gurung
- Annapurna Neurological Institute and Allied Sciences, Nepal
| | - Jayant Yadav
- Annapurna Neurological Institute and Allied Sciences, Nepal.
| | | | - Samir Acharya
- Annapurna Neurological Institute and Allied Sciences, Nepal
| | - Basant Pant
- Annapurna Neurological Institute and Allied Sciences, Nepal
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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.
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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
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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: 4] [Impact Index Per Article: 1.0] [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.
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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
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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.
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Affiliation(s)
| | | | - Dominic Shelby Cervantes
- Department of Neurosurgery, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico
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