Thoracic subarachnoid extraparenchymal neurocysticercosis

a case report of a rare presentation of a persistent public health challenge

Abstract

INTRODUCTION: Neurocysticercosis is the most common parasitic infection of central nervous system. Spinal form incidence is estimated in 0.7 to 3.0% of individuals with neurocysticercosis. Spinal chord form in its intradural variant is the rarest. It consists of a public health problem mainly in developing countries, Brazil being one of the endemic regions.
CASE REPORT: Patient of 59 years old reporting back pain for 2 months, escalating to complete paraplegia with pyramidal signs, with no clear sensory level. Magnetic resonance imaging of thoracic spine consistent with cystic lesion at the level of T4-T5. After multidisciplinary discussion, systemic therapy was initiated and surgical approach proposed. Intraoperative microscopy revealed multiple loculated lesions with apparent scolex in its interior. Histopathological examination confirmed neurocysticercosis.
DISCUSSION: Human cysticercosis occurs by the ingestion of stool released eggs which pass to external environment (fecal-oral route). Neurological impairment severity depends on affected region and degree of inflammation. Diagnosis basis consists on neuro-imaging studies and detection of antigens and antibodies. Treatment includes surgery, symptomatic therapy and anti-parasitic drugs.
CONCLUSION: Sanitary conditions share close relationship with neurocysticercosis and fight against the disease is a World Health Organization (WHO) priority, being one of the seven neglected zoonosis. Cases as exposed are rare and reinforce importance of differential diagnosis and early treatment in order to reduce complications and achievement of better long-term results.