Cysticercose of the central nervous system: II. Spinal cysticercose

Abstract

The compromising of the spinal canal by cysticercus is considered infrequent, varying from 16 to 20% in relation to the brain involvement. In the spinal canal the cysticercus predominantly places in the subarachnoid space. Clinical signs in spinal cysticercosis can be caused by direct compression of the spinal cord/roots by cysticerci and by local or at distance inflammatory reactions (arachnoiditis). Another mechanism of lesion is degeneration of the spinal cord due to pachymeningitis or circulatory insufficiency. The most frequent clinical features are signs of spinal cord and/or cauda equina compression. The diagnosis of spinal cysticercosis is based on evidence of cerebral cysticercosis and on neuroradiological examinations (myelography and myelo-CT) that show signs of arachnoiditis and images of cysts in the subarachnoid space and sometimes, signs of intramedullary lesions, but the confirmation can only be made through immunological reactions in the CSF or during surgery. The clinical course of 10 patients with diagnosis of spinal cysticercosis observed among 182 patients submitted to surgical treatment due to this disease are analyzed. The clinical pictures in all cases were signs of spinal cord or roots compression. All but two presented previously signs of brain cysticercosis. Neuroradiological examinations showed signs of arachnoiditis in 4 patients, images of cysts in the subarachnoid space in 5, and signs of arachnoiditis and images of cysts in one. The 6 patients that presented intraspinal cysts were submitted to exeresis of the cysts and 2 patients with total blockage of the spinal canal underwent surgery for diagnosis. The 2 remaining patients with arachnoiditis and blockage of the spinal canal were clinically treated. All of the six patients submitted to cyst exeresis had initial improvement but 4 of them later developed arachnoiditis and recurrence of the clinical signs and only 2 remained well for long-term. The 2 non operated patients had no improvement of their clinical signs. Two patients died later due to complications of cerebral cysticercosis. Based on the experience acquired in the management of these patients we indicate surgical treatment for patients that present free cyst in subarachnoid space. For those who present arachnoiditis, surgery is indicated only when there is doubt in the diagnosis. Intramedullary cysts should also be surgically treated.

Current Consensus Guidelines for Treatment of Neurocysticercosis

“…b Given the rarity of these presentations, treatment was discussed based on the published literature (22,27). c Experience in the use of albendazole with methylprednisolone for treatment of retinal cysticercosis and as a presurgical treatment for intravitreal cysticercosis has been published (7) but not yet replicated.…”

A Case of Neurocysticercosis in Entire Spinal Level

“…Intradural spinal cysticercosis can be subdivided in leptomeningeal (subarachnoid) or intramedullary forms (parenchymal), and the former is more prevalent than the later. Leptomeningeal form occur in approximately 80% of cases which is assumed to result from larval migration through the ventricular system into the spinal subarachnoid space, where their movement could be assisted by gravity 3) . Queiroz et al 3,9) reported that spinal distribution of cysticerci occured as follows : 34% in the cervical; 44.5% in the thoracic; 15.5% in the lumbar; and 6% in the sacral region.…”

Notificação compulsória da cisticercose em Ribeirão Preto - SP

“…A elevada freqüência de seqüelas confirma a síndrome de HIC como a manifestação mais grave da NCC, merecendo o rótulo de forma maligna, como assinalado por Lima 20 . O envolvimento medular na NCC, embora infrequente, é também motivo de grande preocupação pois, mesmo com a extirpação de cisticercos do canal raquidiano, é freqüente a evolução para paraparesia crural como sequela 10 .…”