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|LETTER TO EDITOR
|Year : 2015 | Volume
| Issue : 1 | Page : 119-120
Isolated conus-epiconus neurocysticercosis
Shonali A Valsangkar, Hrushikesh Umakant Kharosekar, Deepak A Palande, Vernon Velho
Department of Neurosurgery, Sir Jamsetjee Jeejebhoy Group of Hospitals and Grant Medical College, Mumbai, Maharashtra, India
|Date of Web Publication||4-Mar-2015|
Shonali A Valsangkar
Department of Neurosurgery, Sir Jamsetjee Jeejebhoy Group of Hospitals and Grant Medical College, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Valsangkar SA, Kharosekar HU, Palande DA, Velho V. Isolated conus-epiconus neurocysticercosis. Neurol India 2015;63:119-20
Neurocysticercosis (NCC) occurs due to infestation by Taenia solium which is most common parasitic disease of the central nervous system. In endemic areas, the incidence of NCC is 4% in the general population. However, spinal involvement with NCC is rare with a reported incidence of only 1.5-3% of all cases. NCC is classified as extraspinal (vertebral) or intraspinal (epidural, subdural, arachnoidal or intramedullary), of which the intramedullary type is rare with less than 55 cases reported in the literature. We report a case of conus and epiconus intramedullary cysticercosis. 
A 40-year-old male patient presented with progressively worsening radicular pain in both lower limbs with weakness in the toes since 2 months. Since 15 days, he also had sphincteric disturbances. His neurological examination revealed weakness in bilateral external hallucis longus. The ankle reflexes were bilaterally brisk with positive Babinski's sign. Non contrast magnetic resonance (MR) imaging revealed a large intramedullary lesion in the conus and epiconus region displaying heterogeneous low signal intensity on T2 and intermediate signal intensity on T1-weighted images with ring enhancement. Rest of the spinal and brain MR screening was normal [Figure 1] and [Figure 2].
|Figure 1: Magnetic resonance imaging (MRI) dorso-lumbar spine, T1-weighted contrast images showing the lesion|
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|Figure 2: Magnetic resonance imaging (MRI) dorso-lumbar (DL) spine, T2-weighted images, axial cuts|
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The patient underwent a D10 to D12 laminotomy with myelotomy and complete excision of the lesion. During surgery, a cystic lesion with straw colored fluid was seen. The histopathological examination revealed a fibrous wall with a dense, mixed inflammatory infiltrate showing the presence of a single larva [Figure 3]a and b. The postoperative course was uneventful, and the patient was started on oral albendazole with steroids. He improved neurologically and his pain subsided. Albendazole was continued for 6 weeks. At a follow-up after 6 weeks, the patient improved to near normal power with improving sphincteric functions.
The intradural extramedullary form of spinal NCC is 6-8 times more common than the intra-medullary form.  The former occurs as a consequence of the downward migration of the larvae from the cerebral to spinal subarachnoid space. The intramedullary form of NCC is uncommon and usually occurs through hematogenous or ventriculo-ependymal migration [Table 1]. ,,
Patients presenting with acute or progressive neurological deterioration due to compressive symptoms. When the diagnosis is not apparent or in the presence of mass effect, the cyst may be surgically excised.  The long term usage of cysticidal drugs like albendazole and praziquantel are also effective in its management. Corticosteroids are used as adjuncts to the cysticidal therapy to alleviate symptoms due to the inflammatory reaction caused by the death of larvae. 
| » References|| |
Agrawal R, Chauhan SP, Misra V, Singh PA, Gopal NN. Focal spinal intramedullary cysticercosis. Acta Biomed 2008;79:39-41.
Sinha S, Sharma BS. Neurocysticercosis: A review of current status and management. J Clin Neurosci 2009;16:867-76.
Yoo M, Lee CH, Kim KJ, Kim HJ. A case of intradural-extramedullary form of primary spinal cysticercosis misdiagnosed as an arachnoid cyst. J Korean Neurosurg Soc 2014;55:226-9.
Qazi Z, Ojha BK, Chandra A, Singh SK, Srivastava C, Patil TB. Isolated intramedullary spinal cord cysticercosis. J Neurosci Rural Pract 2014;5:S66-8.
[Figure 1], [Figure 2], [Figure 3]
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