Spinal Neurocysticercosis
Spinal Neurocysticercosis
Worldwide, cysticercosis is the most common parasitic infection of the central nervous system. In endemic regions, the incidence of neurocysticercosis (NCC) approaches 4% of the general population. The disease is predominantly intracranial, the authors of most series generally report the incidence of spinal NCC as only 1.5 to 3% of all cases. Although spinal NCC is relatively rare, it represents a distinct clinical entity that can have devastating consequences for the patient. Because of the limited size of the spinal canal, the mass effect of these lesions is poorly tolerated. Most spinal NCC occurs in the subarachnoid space where mass effect can cause spinal cord compression, although obstruction of cerebrospinal fluid pathways due to scarring of the subarachnoid space can also cause symptoms.
The authors treated six patients with spinal NCC. In five cases the lesions were located in the subarachnoid space, and in one the lesion was intramedullary. All patients with subarachnoid spinal NCC required excision of the symptomatic lesions; in two cases initial medical therapy had failed. The patient with intramedullary spinal NCC experienced mild symptoms and underwent steroid therapy. All patients experienced variably improved outcomes and were eventually ambulatory.
Medical therapy should be carefully considered in selected patients in whom symptoms are stable and nonprogressive. Surgical intervention is required when severe or progressive deficits occur to prevent permanent injury. In some patients recovery may be limited as a result of inflammatory injury to the spinal cord or arachnoidal adhesions.
Worldwide, cysticercosis is the most common parasitic infection affecting the CNS. Neurocysticercosis typically involves the brain parenchyma, intracranial subarachnoid space, or ventricular system and is often self-limited unless hydrocephalus requires surgical intervention. Spinal NCC is rare even in endemic regions and may require more aggressive management because of the natural confines of the spinal canal. The location of the mass lesion, its size, and the inflammatory response generated by cyst breakdown are important factors in the management of spinal NCC. We review six cases of spinal NCC in which the patients underwent evaluation and treatment, and we present a review of the literature.
Worldwide, cysticercosis is the most common parasitic infection of the central nervous system. In endemic regions, the incidence of neurocysticercosis (NCC) approaches 4% of the general population. The disease is predominantly intracranial, the authors of most series generally report the incidence of spinal NCC as only 1.5 to 3% of all cases. Although spinal NCC is relatively rare, it represents a distinct clinical entity that can have devastating consequences for the patient. Because of the limited size of the spinal canal, the mass effect of these lesions is poorly tolerated. Most spinal NCC occurs in the subarachnoid space where mass effect can cause spinal cord compression, although obstruction of cerebrospinal fluid pathways due to scarring of the subarachnoid space can also cause symptoms.
The authors treated six patients with spinal NCC. In five cases the lesions were located in the subarachnoid space, and in one the lesion was intramedullary. All patients with subarachnoid spinal NCC required excision of the symptomatic lesions; in two cases initial medical therapy had failed. The patient with intramedullary spinal NCC experienced mild symptoms and underwent steroid therapy. All patients experienced variably improved outcomes and were eventually ambulatory.
Medical therapy should be carefully considered in selected patients in whom symptoms are stable and nonprogressive. Surgical intervention is required when severe or progressive deficits occur to prevent permanent injury. In some patients recovery may be limited as a result of inflammatory injury to the spinal cord or arachnoidal adhesions.
Worldwide, cysticercosis is the most common parasitic infection affecting the CNS. Neurocysticercosis typically involves the brain parenchyma, intracranial subarachnoid space, or ventricular system and is often self-limited unless hydrocephalus requires surgical intervention. Spinal NCC is rare even in endemic regions and may require more aggressive management because of the natural confines of the spinal canal. The location of the mass lesion, its size, and the inflammatory response generated by cyst breakdown are important factors in the management of spinal NCC. We review six cases of spinal NCC in which the patients underwent evaluation and treatment, and we present a review of the literature.
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