Spinal cord cysticercosis: neurosurgical aspects

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The authors report their experience in the treatment of 12 symptomatic patients with intradural spinal neurocysticercosis.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The mean age of the 12 patients was 33 years. There were eight female and four male patients. Cysticercosis was present in association with hydrocephalus in nine cases. In nine of 12 patients the spinal lesion was confined to the thoracic or lumbar spinal cord, and in three the cysticerci occupied the cervical region. In all patients with hydrocephalus nerve root symptoms developed seven to 48 months later (mean 27.6 ± 15.5 months). In one patient hydrocephalus was absent, but he presented with cysticercal meningitis 24 months before spinal cord compression developed. Presenting symptoms suggesting spinal cysticercosis included muscular weakness (67%), pain (67%), and sphincter disturbance (25%). Neurological examination demonstrated a motor deficit in nine patients, sensory deficit in four, and radicular pain in three. The prognosis was worse in patients with moderate-to-severe arachnoiditis and spinal cord compression compared with those with isolated nerve roots involvement in whom outcome was favorable. Ten patients underwent laminectomy, after which neurological status improved in 44%, remained unchanged in 33%, or worsened in 22.2%.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The authors discuss their findings in these cases. Additionally they briefly review the literature, patho-physiology, and therapeutic and/or surgical strategies involved in this disease.</jats:p></jats:sec>

Herniated Lumbar Disc Combined with Spinal Intradural Extramedullary Cysticercosis

“…According to the previous literature, the incidence of spinal cysticercosis ranges from 1 to 3% compared to intracranial cysticercosis 3,15) . Colli et al suggested the hypothesis of "sieve effect" at the transition level between intracranial and intraspinal subarachnoid space to account for the relatively lower incidence of spinal cysticercosis 5) . Spinal cysticercosis can occur in either the subarachnoid space or the spinal cord.…”

“…The most reliable route is the cerebrospinal fluid (CSF). It is thought to result from larval migration through the ventricular system into the spinal subarachnoid space 5) . Intramedullary cysticercosis is considered as a result from the hematogenous spread, but Paterakis et al suggested that, as well as CSF dissemination, hematogenous migration is also possible in cases of extramedullary cysticercosis 1,5,12) .…”

A Case of Neurocysticercosis in Entire Spinal Level

“…The disease may have a pleomorphic quality that is related to individual differences in the number and location of the lesions within the CNS 4,12) . In an older study, the authors reported that 30% also had intracerebral involvement in patients afflicted with spinal cysticercosis, whereas in a more recent study the authors noted 100% concurrent intracere- .…”

Uncommon Clinical Manifestations of Cysticercosis

“…[169] Finally, there are individual differences from the clinical point of view, imaging and of response to treatment according to the number and location of the lesions, that determine the characteristics of the described presentations. [117,160] Neurocysticercosis is always present in patients with DCC.…”

“…The region of provenance of the patient and the characteristics of the MRI images help to establish the difference. [159,160] For this type of presentation there is a general consensus on the poor knowledge and limited experience of the problem. Surgical treatment is recommended alone or combined with APD and corticoids [133,161], although others believe that surgery is the best treatment option for NCCIm counting with current techniques of microsurgery.…”