Indian Journal of Neurosurgery Vol. 3 | Issue 1 | January-April | 2014 54 Cysticercosis of conus medullaris: A case report and literature review Saurabh K. Verma, Vijay Kumar Gupta, M. Narayan Swamy 1 , Harish C. Pathak Departments of Neurosurgery, Command Hospital, Pune, Maharashtra, 1 Command Hospital, Lucknow, Uttar Pradesh, India INTRODUCTION Neurocysticercosis, caused by taenia solium, is the most common parasitic infection affecting the central nervous system. However, the spinal cysticercosis is rare, representing 1.2-5.8% of all cases of neurocysticercosis. [1,2] According to the cysticercus location in spine, cysticercosis has been classified anatomically as extraspinal (vertebral) or intraspinal (epidural, subdural, arachnoid, or intramedullary), of which the intramedullary type is quite rare and only 54 cases have been reported until 2012. [3-8] CASE REPORT This was a case report of a 31-year-old male patient who was transferred to our department from Urology Department with the complaints of voiding dysfunction and constipation for last 1½ years. Neurological examination revealed spastic paraparesis with decreased motor power of grade 3/5 in both lower limbs, impaired sensations below L1 dermatome, brisk tendon jerks and positive Babinski signs on both sides. Magnetic resonance imaging (MRI) revealed a 4.1 cm × 1.9 cm × 1.3 cm well-defined round expansile lesion at T12-L1 vertebral level, in conus medullaris with cystic degeneration and sepate within, heterogeneously hypointense on T1WI [Figure 1a] and hyperintense on T2WI [Figure 1b] with peripheral edema and mild contrast enhancement [Figure 1c], mainly at the antero-inferior limit of cystic part and around it, with the septae also exhibiting enhancement. The subarachnoid space from T12 to L1 vertebra was narrow due to the marked expansion of spinal cord. There were no abnormalities at cervical or lumbar levels or within the brain parenchyma. The diagnosis of intramedullary mass lesion was made. The patient underwent laminectomy from T11 to L2 and the spinal cord was found swollen. When a midline myelotomy was performed at T12-L1 level, a white cystic lesion was seen and clear fluid was then aspirated. The cyst wall of which slightly stuck to the surrounding the spinal cord. In order to dissect the cyst with minimal injury to the peripheral tissue, the cystic liquid was partly withdrawn first and the slackened cyst was removed totally. The liquid was yellowish and transparent. Histological examination [Figure 2] of the resected sample showed cysticercosis. Post-operatively, the patient refused to be treated with anticysticercal agents and steroids. The patient’s Address for correspondence: Dr. Saurabh K. Verma, Departments of Neurosurgery, Command Hospital, Wanorie Pune, Maharashtra, India. E-mail: eskay6362@yahoo.co.in ABSTRACT “Neurocystcercosis” ‑ involvement of the central nervous system (CNS) by taenia solium, is one of the most common parasitc diseases of the CNS. However, spinal involvement by neurocystcercosis is uncommon. Spinal intramedullary cystcercosis involving the conus medullaris is an uncommon clinical conditon, which may mimic an intramedullary tumor and can lead to irreversible neurological defcits if untreated. Here, we report a 31‑year‑old male patent with cystcercosis in the conus medullaris of the spinal cord. Magnetc resonance imaging revealed a well‑defned round intramedullary lesion at D12‑L1 vertebral levels, which was homogeneously hypointense on T1WI and hyperintense on T2WI with peripheral edema. Since the patent had progressive neurological defcits, surgery was performed to decompress the spinal cord. Histopathology examinaton of the removed lesion proved it to be cystcercosis. In this report, we also discuss the principles of diagnosis and treatment of intramedullary cystcercosis in combinaton with literature review. Key words: Cystcercosis, intramedullary, spinal cord Access this article online Quick Response Code: Website: www.ijns.in DOI: 10.4103/2277-9167.132010 CASE REPORT This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.