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Fan J, Tang R, Zhang L, Hoang PT, Ayoade F, Diaz-Perez JA, Moss HE, Jiang H. Atypical Presentations of Extraparenchymal Neurocysticercosis. J Neuroophthalmol 2023; 43:370-375. [PMID: 36637411 PMCID: PMC10318114 DOI: 10.1097/wno.0000000000001782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system and is typically diagnosed through visualization of the cysts in the cerebral parenchyma by neuro-imaging. However, neuro-imaging may not detect extraparenchymal neurocysticercosis (EPNCC), which is a rare manifestation of the disease involving the subarachnoid, meningeal, and intraventricular spaces. We report 2 cases of extraparenchymal neurocysticercosis, and discuss the diagnostic challenges and management of this entity. METHODS Two cases were identified through clinical records. RESULTS Both patients had an insidious onset with slow progression of disease, and presented with papilledema and cerebrospinal fluid (CSF) eosinophilia. One case was diagnosed with spinal cord biopsy. The other was diagnosed with CSF serology and next-generation sequencing-based pathogen analysis. Both patients were treated with ventriculoperitoneal shunt, systemic antiparasitic agents, and immunosuppression. CONCLUSIONS EPNCC is less common than parenchymal NCC. A high level of clinical suspicion is required given its rarity, long incubation period, and slow progression. Diagnosis and treatment can be challenging and requires a multidisciplinary approach.
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Affiliation(s)
- Jason Fan
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Rui Tang
- Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX
| | - Lily Zhang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Phuong T. Hoang
- Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, CA
| | - Folusakin Ayoade
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Julio A. Diaz-Perez
- Department of Pathology & Laboratory Medicine, University of Miami, Miami, FL
- Department of Dermatology, University of Tennessee, Memphis, TN
| | - Heather E. Moss
- Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, CA
- Department of Ophthalmology, Stanford University, Palo Alto, CA
| | - Hong Jiang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
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2
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Manh BH, Dat T, Hai VT, He DV, Ha DD, Que NV, Duc NM. Spinal cysticercosis: A case report. Radiol Case Rep 2023; 18:3269-3273. [PMID: 37483373 PMCID: PMC10359710 DOI: 10.1016/j.radcr.2023.06.037] [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: 02/06/2023] [Revised: 05/24/2023] [Accepted: 06/17/2023] [Indexed: 07/25/2023] Open
Abstract
Spinal cysticercosis is a rare and severe cysticercosis complication. The pathology is from the inflammatory reaction and granuloma formation around the eggs, which cause focal neurological deficits. Because of the rarity of this condition, diagnosis may be delayed and confused with other myelopathies such as neoplasms or myelitis. We report a 42-year-old woman with low back pain and paraplegia. Magnetic resonance imaging showed a lesion in the spinal canal at the level of L4/L5 that was toward the diagnosis of myelitis. The patient underwent an open biopsy, and the result was granulomatosis caused by cysticercosis. The patient was then given an anticysticercosis medication and gradually recovered.
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Affiliation(s)
- Bui Huy Manh
- Neurosurgery Center, Department of Neurosurgery I, Viet Duc Hospital, Hanoi, Viet Nam
| | - Tran Dat
- Neurosurgery Center, Department of Neurosurgery I, Viet Duc Hospital, Hanoi, Viet Nam
- Deparment of Surgery, Hanoi Medical University, Hanoi, Viet Nam
| | - Vu Trung Hai
- Department of Neurosurgery, Hanoi Medical University Hospital, Hanoi, Viet Nam
| | - Dong-Van He
- Neurosurgery Center, Department of Neurosurgery I, Viet Duc Hospital, Hanoi, Viet Nam
| | - Duong Dai Ha
- Neurosurgery Center, Department of Neurosurgery I, Viet Duc Hospital, Hanoi, Viet Nam
- Deparment of Surgery, Hanoi Medical University, Hanoi, Viet Nam
| | - Nguyen-Van Que
- Department of Radiology, Hanoi Medical University Hospital, Hanoi, Viet Nam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
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3
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Tao B, Li T, Ji K, Shang A. Spinal nerve root sleeve cysticercosis: a case report and review of the literature. J Med Case Rep 2023; 17:80. [PMID: 36814326 PMCID: PMC9945364 DOI: 10.1186/s13256-022-03733-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 12/21/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Neurocysticercosis is a parasitic infection of the central nervous system by tapeworm larvae. Spinal cysticercosis is thought to be relatively rare, and spinal nerve root sleeve cysticercosis have not been reported previously. CASE PRESENTATION A 46-year-old Chinese Han female patient presented with low back pain and radicular pain of the right lower limb. The visual analog scale was 6. Magnetic resonance imaging showed a subarachnoid cyst at the S1 level, with a slight enhanced rim. The patient underwent surgical treatment. During surgery, we found the cyst located mainly in the subarachnoid space and partly in a sacral nerve root sleeve. Cysticercosis was also confirmed by postoperative pathological examination. Postoperative drug therapy was performed after cysticercosis was confirmed. Postoperatively, the patient was treated with oral albendazole (15 mg/kg) for 1 month. Only mild sensory impairment was left when she was discharged. After 3 years of follow-up, the visual analog scale reduced from 6 to 2, and the patient's sensory function completely recovered. Magnetic resonance imaging showed no recurrence of cysticercosis. CONCLUSION Subarachnoid cysticercosis may extend to nerve root sleeve causing back pain and radiculopathy, which may present with similar magnetic resonance imaging manifestations to Tarlov cysts. Hence, spinal subarachnoid cysticercosis should be considered as an important differential diagnosis of arachnoid cyst and sacral Tarlov cyst. Combined treatment with surgical removal and drug therapy is effective to manage spinal subarachnoid cysticercosis.
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Affiliation(s)
- Benzhang Tao
- grid.414252.40000 0004 1761 8894Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China ,grid.265021.20000 0000 9792 1228Tianjin Medical University, Tianjin, China
| | - Teng Li
- grid.414252.40000 0004 1761 8894Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China
| | - Kaipeng Ji
- Department of Neurosurgery, Jin Cheng Da Hospital, Jincheng, Shanxi China
| | - Aijia Shang
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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4
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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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5
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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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6
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Parra-Cárdenas DM, Vargas-Cuervo MT, Montejo-Coy JA, Calderon-Vargas CM, Severiche-Bueno DF. Subarachnoid racemose neurocysticercosis with cerebellar involvement: an old friend in an infrequent location? Rev Inst Med Trop Sao Paulo 2021; 63:e43. [PMID: 34161549 PMCID: PMC8216685 DOI: 10.1590/s1678-9946202163043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/12/2021] [Indexed: 11/22/2022] Open
Abstract
Taenia solium is the most common parasitic infection of the central nervous system and it can cause parenchymal or extra-parenchymal lesions. Subarachnoid cysticercosis is a type of extra-parenchymal infection in which the prevalence is not known and racemose NC with cerebellar involvement has been rarely reported. The diagnosis is challenging because of its similarity to other infectious diseases or to subarachnoid involvement of systemic malignancies. Treatment usually requires cysticide drugs, however, there are no randomized studies concerning the anti-parasitic treatment in subarachnoid NC. We present a case of racemose NC in the cerebellar hemisphere to draw attention to this pathology, endemic in many parts of the world; and highlight all the current gaps in our understanding of this entity.
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7
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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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8
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Del Brutto OH. Current approaches to cysticidal drug therapy for neurocysticercosis. Expert Rev Anti Infect Ther 2020; 18:789-798. [DOI: 10.1080/14787210.2020.1761332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Oscar H. Del Brutto
- School of Medicine, Universidad Espíritu Santo, Ecuador, Samborondón, Ecuador
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9
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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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10
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Jobanputra K, Raj K, Yu F, Agarwal A. Intramedullary Neurocysticercosis Mimicking Cord Tumor. J Clin Imaging Sci 2020; 10:7. [PMID: 32123621 PMCID: PMC7049886 DOI: 10.25259/jcis_165_2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 02/10/2020] [Indexed: 11/25/2022] Open
Abstract
Isolated spinal intramedullary involvement by neurocysticercosis is extremely rare. We report a case of a Hispanic female with right-sided weakness, magnetic resonance imaging showing cervical intramedullary lesion. Surgery was performed due to the progressive nature of symptoms. The cervical cord lesion was completely removed; pathology was consistent with degenerated cysticercosis. Progressive clinical improvement with physiotherapy was achieved. Although rare, especially in the absence of intracranial lesions, the diagnosis should be considered in appropriate patient population as it usually presents a peripherally enhancing cystic lesion.
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Affiliation(s)
- Kamlesh Jobanputra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Karuna Raj
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Frank Yu
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Amit Agarwal
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
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11
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Maj E, Wójtowicz K, Aleksandra, Podlecka-Piȩtowska, Prokopienko M, Marchel A, Rowiński O, Bekiesińska-Figatowska M. Intramedullary spinal tumor-like lesions. Acta Radiol 2019; 60:994-1010. [PMID: 30537844 DOI: 10.1177/0284185118809540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The development of magnetic resonance imaging (MRI) has led to an increasingly frequent detection of changes in the spinal cord. The most common intramedullary lesions are: demyelinating; vascular; inflammatory; infectious; and congenital, largely called tumor-like lesions. Spinal cord tumors are relatively rare, as compared with brain tumors. The hardest task is to conclude whether the spinal cord lesion is a tumor or a tumor-like lesion. This review is intended to help evaluate the spinal cord and gives an overview of the tumor-like lesions occurring in the spinal cord along with their characteristic.
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Affiliation(s)
- Edyta Maj
- Second Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | - Marek Prokopienko
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Olgierd Rowiński
- Second Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
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12
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Lopez S, Santillan F, Diaz JJ, Mogrovejo P. Spinal cord compression by multiple cysticercosis. Surg Neurol Int 2019; 10:94. [PMID: 31528432 PMCID: PMC6744808 DOI: 10.25259/sni-46-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/01/2019] [Indexed: 12/04/2022] Open
Abstract
Background: Neurocysticercosis (NCC) is the most common parasitic infection involving the central nervous system in endemic areas. Notably, spinal involvement occurs in only 0.7%–3% of patients. Case Description: A 58-year-old female presented with progressive spinal cord compression attributed to multiple cystic intradural extramedullary thoracic lesions. She underwent laminectomy at two separate thoracic levels; this involved excision of the upper T4–T6, and just exploration of the lower T9–T11 lesions. One year postoperatively, she exhibited a residual paraparesis. Conclusion: Spinal NCC must be considered among the differential diagnostic considerations for patients presenting with spinal intramedullary or subarachnoid/extramedullary cystic lesions. Although they are typically found in endemic regions, those who have traveled to these locations are also susceptible. Even though it is considered a benign condition, spinal NCC may cause permanent and irreversible neurological damage. Public health policies should, therefore, be developed to help control the spread and transmission of NCC.
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Affiliation(s)
- Sebastian Lopez
- Department of Neurosurgery, Santa Ines Hospital, Cuenca, Azuay, Ecuador
| | | | - Juan Jose Diaz
- Department of Family Medicine, System of Public Health, Cuenca, Azuay, Ecuador
| | - Pedro Mogrovejo
- Critical Care Unit, Santa Ines Hospital, Cuenca, Azuay, Ecuador
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13
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Mohanty CB, Fieggen G, Deopujari CE. Pediatric spinal infections-a review of non-tuberculous infections. Childs Nerv Syst 2018; 34:1947-1956. [PMID: 29971483 DOI: 10.1007/s00381-018-3885-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/22/2018] [Indexed: 12/19/2022]
Abstract
Pediatric spinal infection includes spinal epidural abscess, spondylodiscitis and intradural (extramedullary and intramedullary) spinal infections. However, these entities are extremely rare and no clear guidelines exist for their management. Pertinent literature was searched and a detailed narrative review of this topic is presented.
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Affiliation(s)
| | - Graham Fieggen
- Division of Neurosurgery, Red Cross War memorial Children's Hospital and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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14
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Yacoub HA, Goldstein I, El-Ghanem M, Sharer L, Souayah N. Spinal racemose cysticercosis: case report and review. Hosp Pract (1995) 2017; 45:99-103. [PMID: 28468527 DOI: 10.1080/21548331.2017.1325704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Hussam A Yacoub
- a Lehigh Valley Physician Group - Neurology, Lehigh Valley Health Network , Allentown , PA , USA
| | - Ira Goldstein
- b Neurological Institute of New Jersey , Rutgers, the State University of New Jersey , Newark , NJ , USA
| | - Mohammad El-Ghanem
- b Neurological Institute of New Jersey , Rutgers, the State University of New Jersey , Newark , NJ , USA
| | - Leroy Sharer
- c Department of Pathology& Laboratory Medicine , Rutgers, the State University of New Jersey , Newark , NJ , USA
| | - Nizar Souayah
- b Neurological Institute of New Jersey , Rutgers, the State University of New Jersey , Newark , NJ , USA
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15
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Sahu PS, Lim YAL, Mahmud R, Somanath SD, Tan CT, Ramachandran CP. Needs of exploring the burden of recent onset seizures due to neurocysticercosis and challenges in southeast Asia focusing on scenario in Malaysia. ASIAN PAC J TROP MED 2017; 10:332-340. [PMID: 28552103 DOI: 10.1016/j.apjtm.2017.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/10/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022] Open
Abstract
Seizures due to neurocysticercosis (NCC) is a neglected human-to-human transmitted disorder and an emerging problem worldwide. A substantial portion of recent onset seizures is known to be attributed to NCC in Taenia solium (T. solium) endemic areas where populations which neither raise pigs nor eat pig meat are also at risk. High prevalence of NCC causing epilepsy has been reported in the underdeveloped areas of Southeast Asia (SEA) however, only fragmentary information on its incidence is available in countries like Malaysia. In Malaysia T. solium infection was previously thought to be infrequent due to Muslim population majority and the religious prohibition of consuming pork, but it is not totally absent. There is an evident lack of knowledge and awareness of the actual burden, routes of transmission, and the impact of NCC in this region. The problem is assumed to be more prevalent particularly in cities because of the frequent inflow of possibly T. solium infected individuals or carriers among those who migrate from neighboring endemic countries to Malaysia. The issue of imported cases that are likely to be emerging in Malaysia is highlighted here. An accurate quantification of regional burdens of epilepsy due to NCC in Malaysia is warranted considering the disease emergence in its neighboring countries. It is suggested that the importance of NCC be recognized through quantification of its burden, and also to collect epidemiological data for its subsequent elimination in line of World Health Organization's mission for control of cysticercosis as a neglected tropical disease. In this review the need as well as a strategy for neuro-care center screening of epilepsy cases, and various issues with possible explanations are discussed. It is also proposed that NCC be declared as a reportable disease which is one of the eradicable public health problems in SEA.
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Affiliation(s)
- Priyadarshi S Sahu
- Division of Pathology, School of Medicine, International Medical University, 57000 Kuala Lumpur, Malaysia.
| | - Yvonne A L Lim
- Department of Parasitology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Rohela Mahmud
- Department of Parasitology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Sushela D Somanath
- Division of Pathology, School of Medicine, International Medical University, 57000 Kuala Lumpur, Malaysia
| | - Chong T Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - C P Ramachandran
- Programme Review Group, Neglected Tropical Diseases-WHO-Western Pacific Region, Kuala Lumpur, Malaysia
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Santos PJF, Suzuki S, Vadera S. Back Pain and Spinal Cysticercosis. J Clin Neurol 2017; 13:114-115. [PMID: 27868401 PMCID: PMC5242151 DOI: 10.3988/jcn.2017.13.1.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/09/2016] [Accepted: 08/09/2016] [Indexed: 11/17/2022] Open
Affiliation(s)
- Pauline Joy F Santos
- Department of Neurosurgery and Neurology, University of California, Irvine Medical Center, CA, USA
| | - Shuichi Suzuki
- Department of Neurosurgery and Neurology, University of California, Irvine Medical Center, CA, USA
| | - Sumeet Vadera
- Department of Neurosurgery and Neurology, University of California, Irvine Medical Center, CA, USA
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17
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Gordon CA, McManus DP, Jones MK, Gray DJ, Gobert GN. The Increase of Exotic Zoonotic Helminth Infections: The Impact of Urbanization, Climate Change and Globalization. ADVANCES IN PARASITOLOGY 2016; 91:311-97. [PMID: 27015952 DOI: 10.1016/bs.apar.2015.12.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Zoonotic parasitic diseases are increasingly impacting human populations due to the effects of globalization, urbanization and climate change. Here we review the recent literature on the most important helminth zoonoses, including reports of incidence and prevalence. We discuss those helminth diseases which are increasing in endemic areas and consider their geographical spread into new regions within the framework of globalization, urbanization and climate change to determine the effect these variables are having on disease incidence, transmission and the associated challenges presented for public health initiatives, including control and elimination.
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Affiliation(s)
- Catherine A Gordon
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Donald P McManus
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Malcolm K Jones
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; School of Veterinary Science, University of Queensland, Brisbane, QLD, Australia
| | - Darren J Gray
- Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Geoffrey N Gobert
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
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Pant I, Chaturvedi S, Singh G, Gupta S, Kumari R. Spinal cysticercosis: A report of two cases with review of literature. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2016; 7:285-288. [PMID: 27891042 PMCID: PMC5111334 DOI: 10.4103/0974-8237.193261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Neurocysticercosis is the most common parasitic infection of the central nervous system worldwide. However, Cysticercosis affecting the spine is considered extremely rare. We report two cases of spinal cysticercosis with review of literature.
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Affiliation(s)
- Ishita Pant
- Department of Pathology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Sujata Chaturvedi
- Department of Pathology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Gurbachan Singh
- Department of Neurosurgery, Guru Teg Bahadur Hospital, New Delhi, India
| | - Sanjeev Gupta
- Department of Neurosurgery, Guru Teg Bahadur Hospital, New Delhi, India
| | - Rima Kumari
- Department of Neuroradiology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
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19
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Abstract
Study Design Case report. Objective Cysticercosis (parasitic infection caused by Taenia solium) is the most common parasitic infection of the nervous system. However, spinal neurocysticercosis is rare. It can present as an extraspinal or intraspinal lesion, with intramedullary being the rarest location. The symptoms can vary from vague backache and radiculopathy to cauda equine syndrome. Methods We report a 32-year-old man who presented with neurocysticercosis in the lumbar spine and cauda equine syndrome. He had low backache for 1 month, hesitancy in micturition, and decreased perianal sensation for the previous 2 days. Magnetic resonance imaging revealed an intradural extramedullary lesion extending from L2-S1 that was hyperintense in T2- and hypointense in T1-weighted images. Results Because the patient presented with cauda equine syndrome, urgent decompressive laminectomy was done from L2-S1, and the thin-walled cysts with clear fluid were removed. Histopathologic examination confirmed neurocysticercosis. The perianal sensation and the bladder control recovered completely. Conclusion Neurocysticercosis should be considered in the differential diagnosis in patients presenting with a similar picture, and urgent surgical decompression should be attempted to prevent further worsening of the neurologic symptoms.
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Affiliation(s)
- Sudhir Ganesan
- Ortho Spine Department, Sir GangaRam Hospital, New Delhi, India,Address for correspondence Dr. Sudhir Ganesan, MBBS, DNB(Ortho), MNAMS FNB Spine Surgery trainee, Ortho Spine DepartmentSir GangaRam Hospital, Old Rajinder Nagar, New Delhi 110060India
| | - Shankar Acharya
- Ortho Spine Department, Sir GangaRam Hospital, New Delhi, India
| | - K. L. Kalra
- Ortho Spine Department, Sir GangaRam Hospital, New Delhi, India
| | - Rupinder Chahal
- Ortho Spine Department, Sir GangaRam Hospital, New Delhi, India
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Bhardwaj N. Spinal Intramedullary Cysticercosis: A Rare Diagnostic Dilemma. J Emerg Med 2015; 49:e79-80. [PMID: 26104845 DOI: 10.1016/j.jemermed.2014.12.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 10/17/2014] [Accepted: 12/22/2014] [Indexed: 11/28/2022]
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Rahimizadeh A, Soufiani H. Intramedullary arachnoid cyst in association with cervical spondylosis: case report. Spine J 2013; 13:e21-5. [PMID: 23932823 DOI: 10.1016/j.spinee.2013.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 11/19/2012] [Accepted: 05/04/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Intramedullary spinal arachnoid cysts are considered to be very rare, and only 11 cases have been reported previously. Development of such a cyst in association with marked cervical spondylosis has not been reported until recently. PURPOSE Brief review of reported cases and debate on likely treatment strategy when such a cyst is associated with symptomatic spondylosis. STUDY DESIGN To report the first example of a cervicothoracic intramedullary arachnoid cyst along with a symptomatic cervical spondylosis. METHODS Evaluation of quadriparesis in a 58-year-old female resulted in detection of a cervical spondylotic stenosis that was accompanied with an intramedullary cystic lesion. Parallel management of both pathologies was through a wide laminectomy extending from the lower edge of C3 to T2 with subsequent fenestration and partial resection of the cyst wall via an appropriate dorsal entry root zone myelotomy. Cervicothoracic instrumentation from C3 down to T2 was done to prevent postlaminectomy deformity. RESULT Histopathological findings were consistent with the diagnosis of arachnoid cyst. Postoperatively, the patient exhibited marked improvement in neurologic status. CONCLUSION Through the review of the current case, first example from the literature, we concluded that surgery should target toward the proper management of both pathologies in a single-stage operation.
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Affiliation(s)
- Abolfazl Rahimizadeh
- Department of Neurosurgery, Pars Hospital, 83 Keshawarz Blvd, 14154 Tehran, Islamic Republic of Iran.
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Neumayr A, Tamarozzi F, Goblirsch S, Blum J, Brunetti E. Spinal cystic echinococcosis--a systematic analysis and review of the literature: part 1. Epidemiology and anatomy. PLoS Negl Trop Dis 2013; 7:e2450. [PMID: 24086783 PMCID: PMC3783062 DOI: 10.1371/journal.pntd.0002450] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 08/13/2013] [Indexed: 12/29/2022] Open
Abstract
Bone involvement in human cystic echinococcosis (CE) is rare, but affects the spine in
approximately 50% of cases. Despite significant advances in diagnostic imaging techniques as
well as surgical and medical treatment of spinal CE, our basic understanding of the parasite's
predilection for the spine remains incomplete. To fill this gap, we systematically reviewed the
published literature of the last five decades to summarize and analyze the currently existing data
on epidemiological and anatomical aspects of spinal CE. Spinal cystic echinococcosis (CE) is a rare but malignant form of a truly neglected tropical
disease. Despite significant advances in diagnostic imaging techniques as well as surgical and
medical treatment of spinal CE, our basic understanding of the parasite's predilection for the spine
remains poor at best. Information on the influence of parasite and host specific factors on
anatomical manifestations and evolution of CE is currently lacking. We systematically reviewed all
published case reports and case series of spinal CE from 1965 until 2012 to summarize and analyze
the epidemiological and anatomical aspects of the disease and discuss the findings in light of the
existing data.
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Affiliation(s)
- Andreas Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland
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23
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He Q. Commentary. J Neurosci Rural Pract 2013; 4:S120. [PMID: 24174778 PMCID: PMC3808040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Qingyi He
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopedic, Southwest Hospital, Third Military Medical University, 30 Gao Tan Yan Street, Sha Ping Ba District, Chongqing, China 400038,Address for correspondence: Qingyi He, National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopedic, Southwest Hospital, Third Military Medical University, 30 Gao Tan Yan Street, Sha Ping Ba District, Chongqing, China 400038. E-mail:
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Del Brutto OH, Garcia HH. Intramedullary cysticercosis of the spinal cord: A review of patients evaluated with MRI. J Neurol Sci 2013; 331:114-7. [DOI: 10.1016/j.jns.2013.05.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/15/2013] [Accepted: 05/17/2013] [Indexed: 11/25/2022]
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Rice B, Perera P. Intramedullary spinal neurocysticercosis presenting as brown-sequard syndrome. West J Emerg Med 2013; 13:434-6. [PMID: 23316264 PMCID: PMC3541882 DOI: 10.5811/westjem.2011.10.6909] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Accepted: 10/25/2011] [Indexed: 11/22/2022] Open
Abstract
Cysticercosis is an emerging disease in the United States. Neurocysticercosis may rarely cause disease within the spinal cord, but the occurrence of such pathology can produce debilitating symptoms for patients. We present the second report in the literature of intramedullary spinal neurocysticercosis presenting with a Brown-Sequard syndrome.
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Affiliation(s)
- Brian Rice
- University of Southern California, Department of Emergency Medicine, Los Angeles, California
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Abstract
AbstractCerebral involvement in parasitoses is an important clinical manifestation of most of the human parasitoses. Parasites that have been described to affect the central nervous system (CNS), either as the dominant or as a collateral feature, include cestodes (Taenia solium (neurocysticerciasis), Echinococcus granulosus (cerebral cystic echinococcosis), E. multilocularis (cerebral alveolar echinococcosis), Spirometra mansoni (neurosparganosis)), nematodes (Toxocara canis and T. cati (neurotoxocariasis), Trichinella spiralis (neurotrichinelliasis), Angiostrongylus cantonensis and A. costaricensis (neuroangiostrongyliasis), Gnathostoma spinigerum (gnathostomiasis)), trematodes (Schistosoma mansoni (cerebral bilharziosis), Paragonimus westermani (neuroparagonimiasis)), or protozoa (Toxoplasma gondii (neurotoxoplasmosis), Acanthamoeba spp. or Balamuthia mandrillaris (granulomatous amoebic encephalitis), Naegleria (primary amoebic meningo-encephalitis), Entamoeba histolytica (brain abscess), Plasmodium falciparum (cerebral malaria), Trypanosoma brucei gambiense/rhodesiense (sleeping sickness) or Trypanosoma cruzi (cerebral Chagas disease)). Adults or larvae of helminths or protozoa enter the CNS and cause meningitis, encephalitis, ventriculitis, myelitis, ischaemic stroke, bleeding, venous thrombosis or cerebral abscess, clinically manifesting as headache, epilepsy, weakness, cognitive decline, impaired consciousness, confusion, coma or focal neurological deficits. Diagnosis of cerebral parasitoses is dependent on the causative agent. Available diagnostic tools include clinical presentation, blood tests (eosinophilia, plasmodia in blood smear, antibodies against the parasite), cerebrospinal fluid (CSF) investigations, imaging findings and occasionally cerebral biopsy. Treatment relies on drugs and sometimes surgery. Outcome of cerebral parasitoses is highly variable, depending on the effect of drugs, whether they are self-limiting (e.g. Angiostrongylus costaricensis) or whether they remain undetected or asymptomatic, like 25% of neurocysticerciasis cases.
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