Acute dorsal myelopathy resulting from intramedullary cysticercus: a case report

Durjoy Lahiri,Abhishek Chowdhury,Biman Kanti Ray,Souvik Dubey

doi:10.1186/s13256-021-02693-w

Abstract

BackgroundNeurocysticercosis is the most common parasitic infection of the central nervous system, brain being the most frequent site. Intramedullary location of cysticercus is a rarely described entity in literature. Widespread dissemination of cysticercus is also considered a rare occurrence, and only a handful of cases are documented, almost exclusively from tropical nations. Here we present a case of disseminated cysticercosis with rare initial presentation as acute dorsal myelopathy resulting from intramedullary cysticercus.Case presentationA 62-year-old male patient from India (Asian) presented with features of dorsal myelopathy as manifested by acute-onset symmetric paraparesis, sensory loss below umbilicus, and double sphincter dysfunction. General physical examination revealed pea-sized nodules in skin and tongue. On spinal cord imaging, it was found that he had intramedullary cysticercus with diffuse perilesional edema. Brain and muscle imaging showed extensive cysticercosis suggestive of dissemination. Histological examination from skin nodule and antibody assay confirmed the diagnosis of cysticercosis. Following steroid administration, our patient showed improvement with observable increase in power of the lower limbs. He was subsequently discharged with antiepileptics, symptomatic therapy, and regular physiotherapy. Antihelminthic agents were initially avoided in view of extensive cysticercosis in brain including crucial areas such as brainstem.ConclusionRare manifestation of a rare but treatable disorder makes it an important reportable observation in the context of tropical medicine.

Highlights

Neurocysticercosis is the most common parasitic infection of the central nervous system, brain being the most frequent site
Typical presentation of spinal cord neurocysticercosis is in the form of compressive myelopathy with a chronic progressive clinical course
To the best of our knowledge, the presented case is the first report of intramedullary neurocysticercosis that manifested as acute dorsal myelopathy mimicking transverse myelitis

Summary

Background

Cysticercosis is caused by Cysticercus cellulose, a larval form of pork tape worm Taenia solium. There was associated double sphincter dysfunction, for the same duration, in the form of acute painless retention of urine and constipation He was put on a catheter on the third day of illness that remained in situ at the time of admission to our care. Magnetic resonance imaging (MRI) of dorso-lumbar spine with contrast, which was done outside approximately 1 week following symptom onset, showed small rim enhancing lesion in the spinal cord at D11 level with edema in the surrounding cord as well as diffuse cystic lesions in skeletal muscles and brain parenchyma consistent with cysticercosis. Within 5–7 days our patient showed improvement with observable increase in power of the lower limbs up to the extent of 3/5 He was subsequently discharged with antiepileptics (tablet levetiracetam 500 mg twice daily), symptomatic therapy, and regular physiotherapy. The patient was lost in follow up after 3 months following discharge from our care

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