Comments on Spinal Intramedullary Cysticercosis

Abstract

The recent article on spinal intramedullary cysticercosis is interesting ( 1 Bhardwaj N. Spinal intramedullary cysticercosis: a rare diagnostic dilemma. J Emerg Med. 2015; 49: e79-e80 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar ). The author claims it was a rare diagnostic dilemma. In fact, cysticercus can be found in any organ, but is uncommon in the spinal canal. This condition must be ruled out in the differential diagnosis for any patient with an abnormal spinal lesion ( 2 Wiwanitkit V. Spinal cysticercosis. Fetal Pediatr Pathol. 2013; 32: 151 Crossref PubMed Scopus (1) Google Scholar ). The first presentation might be neurologic deficit, but sometimes it can be an acute problem presenting to the emergency department (such as Brown–Séquard syndrome) ( 2 Wiwanitkit V. Spinal cysticercosis. Fetal Pediatr Pathol. 2013; 32: 151 Crossref PubMed Scopus (1) Google Scholar , 3 Salazar Noguera E.M. Pineda Sic R. Escoto Solis F. Intramedullary spinal cord neurocysticercosis presenting as Brown-Séquard syndrome. BMC Neurol. 2015; 15: 1 Crossref PubMed Scopus (10) Google Scholar , 4 Ahmed S. Paul S.P. Intramedullary spinal neurocysticercosis treated successfully with medical therapy. J Egypt Soc Parasitol. 2014; 44: 661-664 Crossref PubMed Scopus (3) Google Scholar ). There should be no problem in diagnosis if the practitioner is aware of this medical disorder ( 2 Wiwanitkit V. Spinal cysticercosis. Fetal Pediatr Pathol. 2013; 32: 151 Crossref PubMed Scopus (1) Google Scholar , 3 Salazar Noguera E.M. Pineda Sic R. Escoto Solis F. Intramedullary spinal cord neurocysticercosis presenting as Brown-Séquard syndrome. BMC Neurol. 2015; 15: 1 Crossref PubMed Scopus (10) Google Scholar , 4 Ahmed S. Paul S.P. Intramedullary spinal neurocysticercosis treated successfully with medical therapy. J Egypt Soc Parasitol. 2014; 44: 661-664 Crossref PubMed Scopus (3) Google Scholar , 5 Agale S.V. Bhavsar S. Choudhury B. Manohar V. Isolated intramedullary spinal cord cysticercosis. Asian J Neurosurg. 2012; 7: 90-92 Crossref PubMed Google Scholar ). The issue is not a diagnostic dilemma, but it is a topic that the practitioner must learn and study. As noted by Ahmed and Paul, “Magnetic resonance imaging (MRI) scan can accurately diagnose spinal or cerebral lesions and is also helpful in monitoring progress while on treatment” ( 4 Ahmed S. Paul S.P. Intramedullary spinal neurocysticercosis treated successfully with medical therapy. J Egypt Soc Parasitol. 2014; 44: 661-664 Crossref PubMed Scopus (3) Google Scholar ). In managing a case, the use of medical therapy can result in a favorable outcome ( 4 Ahmed S. Paul S.P. Intramedullary spinal neurocysticercosis treated successfully with medical therapy. J Egypt Soc Parasitol. 2014; 44: 661-664 Crossref PubMed Scopus (3) Google Scholar ). Response to Letter to the EditorJournal of Emergency MedicineVol. 52Issue 1PreviewI appreciate the comments made by Sora Yasri and Viraj Wiwanitkit about my article. Isolated spinal intramedullary cysticercosis is a rare lesion with a nonspecific clinical presentation. More and more cases are being diagnosed with advances in neuroimaging and awareness of this entity, but this remains an imaging diagnosis. The imaging shows a ring or nodular enhancing lesion with perilesional edema; it must be differentiated from other neoplastic (i.e., primary and secondary) and granulomatous lesions (e.g., tuberculosis granuloma and sarcoidosis) of the spinal cord (1,2). Full-Text PDF