Top

BMC Neurology

Published in:

Open Access 01-12-2022 | Magnetic Resonance Imaging | Research article

Spinal cysticercosis: a rare cause of myelopathy

Authors: Chenlong Yang, Tie Liu, Jian Wu, Jingcheng Xie, Tao Yu, Wenqing Jia, Jun Yang, Yulun Xu

Published in: BMC Neurology | Issue 1/2022

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.

White AC Jr, Coyle CM, Rajshekhar V, Singh G, Hauser WA, Mohanty A, et al. Diagnosis and Treatment of Neurocysticercosis: 2017 Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis. 2018;66(8):e49–75. https://doi.org/10.1093/cid/cix1084.CrossRefPubMedPubMedCentral

Del Brutto OH, Garcia HH. Taenia solium Cysticercosis--The lessons of history. J Neurol Sci. 2015;359(1–2):392–5. https://doi.org/10.1016/j.jns.2015.08.011.CrossRefPubMed

Del Brutto OH. Neurocysticercosis. Handb Clin Neurol. 2014;121:1445–59. https://doi.org/10.1016/B978-0-7020-4088-7.00097-3.CrossRefPubMed

Küchenmeister F. Offenes sendschreiben an die kk Gessellschaft der Aertze zu Wein. Experimenteller Nachweis, dass Cysticercus cellulosae innerhab des menschlichen Darmkanales sich in Taenia solium umwandelt. Wien Med Wochenschr. 1855;5:1–4.

Yoshino K. Studies on the post-embryonal development of Taenia solium. Part I. On the hatching of the eggs of Taenia solium. Taiwan Igakkai Zasshi= J Med Assoc Formosa. 1933;32(343):10.

Yoshino K. Studies on the post-embryonal development of Taenia solium. Part II. On the migration course of the oncosphere of Taenia solium within the intermediate host. J Med Assoc Formosa. 1933;32:155–8.

Del Brutto OH, Rajshekhar V, White AC Jr, Tsang VC, Nash TE, Takayanagui OM, et al. Proposed diagnostic criteria for neurocysticercosis. Neurology. 2001;57(2):177–83. https://doi.org/10.1212/wnl.57.2.177.CrossRefPubMed

Nash TE, Garcia HH. Diagnosis and treatment of neurocysticercosis. Nat Rev Neurol. 2011;7(10):584–94. https://doi.org/10.1038/nrneurol.2011.135.CrossRefPubMedPubMedCentral

Callacondo D, Garcia HH, Gonzales I, Escalante D, Nash TE. Cysticercosis Working Group in P. High frequency of spinal involvement in patients with basal subarachnoid neurocysticercosis. Neurology. 2012;78(18):1394–400. https://doi.org/10.1212/WNL.0b013e318253d641.CrossRefPubMedPubMedCentral

10.

Qazi Z, Ojha BK, Chandra A, Singh SK, Srivastava C, Patil TB. Isolated intramedullary spinal cord cysticercosis. J Neurosci Rural Pract. 2014;5(Suppl 1):S66–8. https://doi.org/10.4103/0976-3147.145209.CrossRefPubMedPubMedCentral

11.

Cantey PT, Coyle CM, Sorvillo FJ, Wilkins PP, Starr MC, Nash TE. Neglected parasitic infections in the United States: cysticercosis. Am J Trop Med Hyg. 2014;90(5):805–9. https://doi.org/10.4269/ajtmh.13-0724.CrossRefPubMedPubMedCentral

12.

Garcia HH, Evans CA, Nash TE, Takayanagui OM, White AC Jr, Botero D, et al. Current consensus guidelines for treatment of neurocysticercosis. Clin Microbiol Rev. 2002;15(4):747–56. https://doi.org/10.1128/cmr.15.4.747-756.2002.CrossRefPubMedPubMedCentral

13.

Agrawal R, Chauhan SP, Misra V, Singh PA, Gopal NN. Focal spinal intramedullary cysticercosis. Acta Biomed. 2008;79(1):39–41.PubMed

14.

Ahmad FU, Sharma BS. Treatment of intramedullary spinal cysticercosis: report of 2 cases and review of literature. Surg Neurol. 2007;67(1):74–7discussion 7;. https://doi.org/10.1016/j.surneu.2006.03.034.CrossRefPubMed

15.

Chhiber SS, Singh B, Bansal P, Pandita KK, Razdan S, Singh J. Intramedullary spinal cysticercosis cured with medical therapy: case report and review of literature. Surg Neurol. 2009;72(6):765–8discussion 8-9. https://doi.org/10.1016/j.surneu.2009.06.011.CrossRefPubMed

16.

Singh P, Sahai K. Intramedullary cysticercosis. Neurol India. 2004;52(2):264–5.PubMed

17.

Agale SV, Bhavsar S, Choudhury B, Manohar V. Isolated intramedullary spinal cord cysticercosis. Asian J Neurosurg. 2012;7(2):90–2. https://doi.org/10.4103/1793-5482.98655.CrossRefPubMedPubMedCentral

18.

Azfar SF, Kirmani S, Badar F, Ahmad I. Isolated intramedullary spinal cysticercosis in a 10-year-old female showing dramatic response with albendazole. J Pediatr Neurosci. 2011;6(1):52–4. https://doi.org/10.4103/1817-1745.84409.CrossRefPubMedPubMedCentral

19.

Bhardwaj N. Spinal Intramedullary Cysticercosis: A Rare Diagnostic Dilemma. J Emerg Med. 2015;49(3):e79–80. https://doi.org/10.1016/j.jemermed.2014.12.094.CrossRefPubMed

20.

Joob B, Wiwanitkit V. Spinal Intramedullary Cysticercosis: A Summary of Three Cases in Thailand. Ann Indian Acad Neurol. 2018;21(1):87–8. https://doi.org/10.4103/aian.AIAN_370_17.CrossRefPubMedPubMedCentral

21.

Kim M, Rhim SC, Khang SK. Intramedullary spinal cysticercosis: a case report and review of literature. Korean J Spine. 2014;11(2):81–4. https://doi.org/10.14245/kjs.2014.11.2.81.CrossRefPubMedPubMedCentral

22.

Lin J, Chu W, Ye X. Use of suction to treat intramedullary spinal cysticercosis. BMJ Case Rep. 2010;2010. https://doi.org/10.1136/bcr.04.2009.1755.

23.

Maste PS, Lokanath YK, Mahantshetti SS, Soumya S. Isolated Intramedullary Spinal Cysticercosis: A Case Report with Review of Literature of a Rare Presentation. Asian J Neurosurg. 2018;13(1):154–6. https://doi.org/10.4103/1793-5482.180894.CrossRefPubMedPubMedCentral

24.

Qi B, Ge P, Yang H, Bi C, Li Y. Spinal intramedullary cysticercosis: a case report and literature review. Int J Med Sci. 2011;8(5):420–3. https://doi.org/10.7150/ijms.8.420.CrossRefPubMedPubMedCentral

25.

Colli BO, Valenca MM, Carlotti CG Jr, Machado HR, Assirati JA Jr. Spinal cord cysticercosis: neurosurgical aspects. Neurosurg Focus. 2002;12(6):e9.PubMed

26.

Dantas FL, Fagundes-Pereyra WJ, De CTS, Vega MG, De AAS. Intramedullary cysticercosis: case report. Arq Neuropsiquiatr. 1999;57(2A):301–5.CrossRef

27.

Choi KB, Hwang BW, Choi WG, Lee SH. Herniated lumbar disc combined with spinal intradural extramedullary cysticercosis. J Korean Neurosurg Soc. 2010;48(6):547–50. https://doi.org/10.3340/jkns.2010.48.6.547.CrossRefPubMedPubMedCentral

28.

Izci Y, Moftakhar R, Salamat MS, Baskaya MK. Spinal intramedullary cysticercosis of the conus medullaris. WMJ. 2008;107(1):37–9.PubMed

29.

Machado LR, Livramento JA, Vaz AJ, Bueno EC, Mielli SR, Bastouly V, et al. IgG intrathecal synthesis and specific antibody index in patients with neurocysticercosis. Arq Neuropsiquiatr. 2002;60(2-B):395–9. https://doi.org/10.1590/s0004-282x2002000300011.CrossRefPubMed

30.

Del Brutto OH, Garcia HH. Intramedullary cysticercosis of the spinal cord: a review of patients evaluated with MRI. J Neurol Sci. 2013;331(1–2):114–7. https://doi.org/10.1016/j.jns.2013.05.025.CrossRefPubMed

31.

Barrie U, Badejo O, Aoun SG, Adeyemo E, Moler N, Christian ZK, et al. Systematic Review and Meta-Analysis of Management Strategies and Outcomes in Adult Spinal Neurocysticercosis. World Neurosurg. 2020;138:504–11 e8. https://doi.org/10.1016/j.wneu.2020.03.093.CrossRefPubMed

32.

Corral I, Quereda C, Moreno A, Lopez-Velez R, Martinez-San-Millan J, Guerrero A, et al. Intramedullary cysticercosis cured with drug treatment. A case report. Spine (Phila Pa 1976). 1996;21(19):2284–7. https://doi.org/10.1097/00007632-199610010-00023.CrossRef

33.

White AC, Coyle CM. Diagnosis and management of neurocysticercosis: will real time PCR help? Clin Infect Dis. 2019. https://doi.org/10.1093/cid/ciz543.

34.

Sotelo J, Marin C. Hydrocephalus secondary to cysticercotic arachnoiditis. A long-term follow-up review of 92 cases. J Neurosurg. 1987;66(5):686–9. https://doi.org/10.3171/jns.1987.66.5.0686.CrossRefPubMed

35.

Mitchell WG, Snodgrass SR. Intraparenchymal cerebral cysticercosis in children: a benign prognosis. Pediatr Neurol. 1985;1(3):151–6. https://doi.org/10.1016/0887-8994(85)90054-2.CrossRefPubMed

Title: Spinal cysticercosis: a rare cause of myelopathy
Authors: Chenlong Yang
Tie Liu
Jian Wu
Jingcheng Xie
Tao Yu
Wenqing Jia
Jun Yang
Yulun Xu
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Albendazole
Published in: BMC Neurology / Issue 1/2022
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-022-02589-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Spinal cysticercosis: a rare cause of myelopathy

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2022

Does COVID-19 increase the long-term relapsing-remitting multiple sclerosis clinical activity? A cohort study

What web-based information is available for people with Parkinson’s disease interested in aquatic physiotherapy? A social listening study

Optimal therapeutic conditions for the neural stem cell-based management of ischemic stroke: a systematic review and network meta-analysis based on animal studies

Brainstem lesions are associated with diffuse spinal cord involvement in early multiple sclerosis

Plasma and cerebrospinal fluid neurofilament light concentrations reflect neuronal damage in systemic lupus Erythematosus

Current physical therapy practice and implementation factors regarding the evidence-based ‘Rehabilitation of Mobility after Stroke (ReMoS)’ guideline in Germany: a cross-sectional online survey