intramedullary neurocysticercosis
TRANSCRIPT
DR REKHA KHARE MD RADIOLOGY
A young man was referred from neurology OPD for MRI cervical spine with the complaints of numbness of left arm, for last six months
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
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
Contrast MRI shows: A Ring enhanced lesion with central enhanced nidus and moderate perilesional oedma
Minimal focal syrinx at the level of lesion
Ring enhanced lesion: commonest Tuberculoma and Neurocysticercosis
Other Intramedullary cystic lesion: infection/ abscess,
arachnoid cyst,ependymal cyst,
neurentric cyst, sarcoidosis,neoplasm
Our case was straight forward case ofIntramedullary 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
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
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
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
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
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
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
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
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
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
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