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Intramedullary neurocysticercosis



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it is quite uncommon lesion. The case has presented with numbness bit unusual symptom for neurocysticercosis.

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Intramedullary neurocysticercosis

  2. 2.  A young man was referred from neurology OPD for MRI cervical spine with the complaints of numbness of left arm, for last six months
  3. 3.  Neurological exam. revealed normal higher mental and cranial nerve function  No motor power loss is noticed in left arm, grip was normal  X-ray cervical spine - AP and Lateral view shows nothing significant  Routine Lab examination was found with in normal limit
  4. 4.  All standard sequences were taken  Non contrast MRI revealed an relatively well defined cystic nodular intramedullary hypo intense lesion on T1W1 sequence with hyper intense nidus lesion in the center at C2-3 level  Lesion gets hyper intense on T2 W1 sequence with mild hyper density in surrounding area
  5. 5.  Contrast MRI shows: A Ring enhanced lesion with central enhanced nidus and moderate perilesional oedma  Minimal focal syrinx at the level of lesion
  6. 6.  Ring enhanced lesion: commonest Tuberculoma and Neurocysticercosis  Other Intramedullary cystic lesion: infection/ abscess, arachnoid cyst,ependymal cyst, neurentric cyst, sarcoidosis,neoplasm
  7. 7.  Our case was straight forward case of Intramedullary Cysticercosis – Ring enhanced lesion with pin point dot calcification in the center and oedma in surrounding tissue ** focal syrinx could be the possible reason of the only symptom of Numbness
  8. 8.  Cysticercosis is a parasitic disease caused by larval stage of Taenia solium  Cysticercosis in human is first described in 1550 by Pranoli  Cysticercosis is endemic in Indian subcontinent
  9. 9.  Commonly cysticercosis occurs due to either ingestion of contaminated vegetables, eaten raw or oral-faecal route  Disease is not restricted to the pork eater who usually harbour the adult parasite
  10. 10.  Cysticercosis CNS is common in poor developing region esp. in pediatric age group  Incidence of neurocysticercosis is about 4% of the general population  Isolated Spinal intramedullary cysticercosis is quite rare compared to spinal subarachnoid cysticercosis
  11. 11.  It has been described very little. The proposed mechanism of spread is hematogenous dissemination  As thoracic cord receives maximum blood so it is most commonly affected
  12. 12.  Most Possible pathogenesis through ventriculo-ependymal spread by migration of larva from ventricle along CSF down to spinal subarachnoid space  Majority of cysticerci can not pass through the subarachnoid space at the cervical level due to its size and physiological sieve
  13. 13.  Cyst may increase with in cord and so produce symptoms like that of small syrinx  Toxic effects include local inflammation secondary to leakage of parasitic metabolic by product with in the cyst fluid  Vascular compromise secondarily results in cord ischemia and myelomalacia
  14. 14. Tuberculoma  Irregular in shape  Solid  Ring enhanced lesion more than 2cm  Severe perilesional oedma with mass effect/ focal neurological deficit  TB else where Neurocysticercosis  Round  Cystic  Ring enhanced lesion less than 2cm with visible scolex/nidus.. Target lesion  Perilesional oedma not enough to produce mass effect
  15. 15.  Intramedullary cysticercosis represents a diagnostic challenge  TARGET LESION: Ring enhanced small lesion with pin point dense center/scolex and usually with mild perilesional oedma is quite characteristic  it should be strongly considered in low socio- economic poor developing area
  16. 16.  Major cause of adult onset Epilepsy in the developing world  CNS and eye involvement is termed as Neurocysticercosis  Predilection for migration to eyes, CNS and striated muscle probably due to increased glycogen and glucose content of these tissue  Radiological staging: visible cyst with scolex degenerating cyst calcified cyst
  17. 17.  Bin Qi,Pengfei Ge, Hongfa Yang, Chunhua Bi and YipingLi. Spinal Intramedullary Cysticercosis: A case Report and Literature Review: Int J Med Sci 2011;8(5)420-423  Kumar S, Handa A, Chavda S. et al. Intramedullary cysticercosis. J Clin Neurosci.2010;17(4): 522-3[pub med]  Lt Col PK Sahoo. Spinal Intramedullary Cysticercosis.MJAFI2000,56:240-241  Mathuria SN, Khosla VK, Vasistha RK et al Intramedullary cysticercosis;MRI diagnosis.Neurol India.2001;49(10: 71-4[pub med]
  18. 18.  Shubhangi V Agale, Shweta Bhavsar and Vidhya Manohar: Isolated intramedullary spinal cord cysticercosis. Asian J Neurosurg.2012 Apr- Jun;7(2):90-92  Singh p, Sahai K. Intramedullary cysticercosis. NeurolIndia 2004:52:264-5(pub Med)  Taveras JM,Wood Eh. Diagnostic neuro radiology. 2nd ed.Baltimore The Williams and Wilkins company 1977:1162
  19. 19. HAVE A NICE DAY