Spinal neurocysticercosis

Case contributed by Dr Ng Thanh Van Anh

Presentation

Lower extremities weakness, anal sphincter dysfunction, and urinary retention

Patient Data

Age: 26
Gender: Female
MRI

MRI showed intradural - extramedullary diffuse lesions in the lumbar canal amongst the cauda equina. The lesions were hypointense in T1W, heterogeneous hypointense in T2W compared to CSF. After contrast, it showed heterogeneous rim enhancement. DWI and ADC showed restricted diffusion. 

The patient went on posterior laminectomy. The lesions were the diffuse, infiltrative below the conus medullaris which spread along with the nerve roots and severe adhesion between the dural and cauda equina. They were dissected and removed at maximum.

 

 

 

Pathology

H&E staining indicated an eosinophilic outer cuticle layer and a single layer sub - cuticle cell

Histological reveal typical cysticercosis.

Case Discussion

 

The patient was treated with Albendazole after that. 

Isolated spinal cysticercosis is extremely rare. The majority of spinal SCC is extramedullary intradural form. MRI features of spinal SCC include cystic, diffuse arachnoiditis, or a mixture of both. This case demonstrates findings of diffuse arachnoiditis form of spinal cysticercosis. 

 Diffuse arachnoiditis form is rare and probably from inflammatory reaction due to the rupture of the cysticercosis cyst into subarachnoid space. Lesions are diffuse in the entire lumbar spine like this case, with or without multiple small cysts, show heterogeneous enhancement after contrast. The imaging is atypical but with some cases were reported, they almost look similar to each other. 

 

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