A Rare Case of Isolated Intramedullary Cervical Spine Neurocysticercosis That Was Initially Misdiagnosed and Treated as Demyelinating Disease-A Case Report. (P2.322)

OBJECTIVE: To perform a review of spinal cord cystircercosis and to discuss presentation, diagnosis, imaging and early suspicion to achieve early diagnosis and management of this rare disease. BACKGROUND: Cystircercosis can affect multiple organ systems within the body. It is the most common parasitic infection of the central-nervous-system(CNS). It occurs by ingestion of water or food contaminated by the ova of the cestode, Taenia-Solium. Most often the brain is affected, but in rare cases the spinal cord is involved. We report an extremely rare case of isolated intramedullary cervical-spine neurocysticercosis. DESIGN/METHODS: A 36-year-old Hispanic-male presented with 15-days numbness and weakness in all extremities and numbness in the saddle-area. Symptoms started suddenly while working in his farm, and worsened daily. Examination revealed normal mental status and cranial nerves, hyperreflexia in all extremities, positive Hoffman’s bilaterally, bilateral lower extremity(BLE) weakness and decreased light-touch sensation. RESULTS: MRI-brain showed non-specific findings. MRI-spinal-cord showed intramedullary hemorrhagic lesion within the cervical cord(C3-C5 level), with abnormal cord signal from C2-T3. CSF-studies revealed elevated glucose and total protein and positive oligoclonal-bands. Consequently, demyelinating disease was suspected and IV-steroids with very-slow oral taper was initiated. Follow-up MRI in 3 and 6 months showed less enhancement/edema, with worsening of the intramedullary lesion. Patient symptoms progressed to bladder and bowel incontinence and worsening BLE weakness. Therefore, C3-C5 laminectomy with open-cord biopsy was performed. Pathology confirmed intramedullary-cysticercosis and treatment with albendazole and steroids were initiated, with significant symptomatic improvement. CONCLUSION: Spinal-cystircercosis is rare, comprising only 1 % of cases. It is especially uncommon in the cervical region, where the narrow spaces make it difficult for the cystercerci to pass into subarachnoid-space. Symptoms of spinal involvement may include muscular weakness, sensory-disturbances and bowel/bladder incontinence. Early diagnosis and treatment can help achieve full-recovery. Therefore, physicians must keep high-suspicion, even when history-of-exposure is unclear. Spinal-imaging may reveal cystic-lesions, leptomeingeal enhancement, enhancing lesions, or calcifications. Treatment includes combination of antiparasitic agents(albendazole) and corticosteroids and/or surgical resection. Disclosure: Dr. Dixon has nothing to disclose. Dr. Suradi has nothing to disclose. Dr. Chichkova has nothing to disclose.