Introduction: Intradural extramedullary cervical spinal neurocysticercosis is an uncommon manifestation of neurocysticercosis. We report a case of a middle-aged man with neurocysticercosis infection in the intradural extramedullary cervical spine and brain who originally presented with bilateral parasthesia of his extremities and progressively unsteady gait.
Methods: A 49 year old male from Guatemala with a history of pulmonary tuberculosis and seizures presented with bilateral parasthesia of his extremities and progressively unsteady gait.
Results: On physical exam he had patchy loss of sensations in his upper extremities bilaterally. There was also decreased sensation noted in his lower extremities bilaterally below the L1-L2 dermatomes. He had bilateral proximal muscle weakness of his upper and lower extremities at 4 to 4+. Deep tendon reflexes were brisk at 3+ and symmetric throughout. He had a bilateral upgoing Babinski sign. The patient had dysmetria on the finger-to-nose test and decreased amplitude of rapid alternating movements. His gait was wide-based and unsteady. Ophthalmologic exam was normal. Magnetic resonance (MR) imaging of the cervical spine (Figure 1) demonstrated large polycystic lesions, prominent dorsally, enhancing, and compressing the spinal cord. This was most prominent at the posterior fossa through C2 with additional area of stenosis at C6-C7. Further studies had been obtained including a computed tomography (CT) scan of the brain that demonstrated multiple calcific nodules throughout the parenchyma. Additional MR imaging revealed multiple sites of small enhancing lesions throughout the brain parenchyma. The MR imaging of thoracolumbar spine demonstrated an enhancement along the cord surface diffusely with large nodules in the lower lumbar spine.
Conclusions: The patient elected for surgical treatment and underwent a suboccipital craniectomy, C1 laminectomy, resection of intradural extramedullary lesions, untethering of cervical spinal cord. Histopathology analysis of the cyst revealed racemose neurocysticercosis. He continued to improve clinically and had no recurrence of cystic lesions.
Patient Care: Although intradural extramedullary cervical spinal neurocysticercosis is a rare disease, it should be considered in the differential, especially in patients from endemic areas who have MRI findings of polycystic lesions. Additionally, surgical intervention should be considered as a viable treatment option, particularly in cases with large, complex cystic structures that can freely mobilize.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the importance of intradural extramedullary cervical spinal neurocysticercosis.
2) Discuss, in small groups, the presentation, diagnosis, and treatment options for intradural extramedullary cervical spinal neurocysticercosis.
3) Identify an effective treatment for intradural extramedullary cervical spinal neurocysticercosis.