SCIENTIFIC LETTER Intramedullary Neurocysticercosis Successfully Treated with Medical Therapy Kuldeep Yadav 1 & Deepali Garg 1 & Jaya Shankar Kaushik 1 & N. D. Vaswani 1 & Rachana Dubey 2 & Shalini Agarwal 3 Received: 13 February 2017 /Accepted: 10 April 2017 # Dr. K C Chaudhuri Foundation 2017 To the Editor: Spinal cysticercosis is a rare presentation of neurocysticercosis. Surgical excision of cysticercus followed by cysticidal therapy remains the mainstay of treatment [1]. Authors have reported variable success of treating intramedullary cysticercus with praziquantel or albendazole alone [ 2 –4]. Treatment with cysticidal drug alone in intramedullary lesion remains controversial and paradoxical worsening is feared [5]. We describe an eight-year-old boy with a history of back pain and slowly progressive weakness of both upper limbs and lower limbs for the last 1 mo. Weakness was most prominent in left upper limb with a history of numb- ness in entire left upper extremity. Examination revealed spinal tenderness along the cervical and thoracic spine. Motor system examination revealed asymmetric spastic quadriparesis (left upper limb predominant) with brisk deep tendon reflexes and extensor plantar response bilat- erally. Sensory examination showed decreased response to pain from C6 dermatome to T1 dermatome on left upper limb. Magnetic resonance imaging (MRI) spine revealed intradural intramedullary cysticercosis at C5-C6 level with surrounding cord edema (Fig. 1). MRI brain study was normal. He was started on albendazole therapy (15 mg/kg/d) for 28 d under the cover of oral dexa- methasone (0.6 mg/kg/d for 5 d). He had a remarkable improvement in motor weakness and sensory symptoms. In view of clinical improvement with medical treatment, surgically inaccessible intramedullary lesion and fear of post-operative myelotomy related complication, surgical intervention was deferred. At 4 wk follow-up, he had no residual motor weakness and complete resolution of sensory symptoms. There were no adverse effects in terms of the fresh neurological deficit on oral albendazole therapy. The presence of ring enhancing lesion with an eccen- tric scolex in an endemic area favors neurocysticercosis over other radiological differentials of the intramedullary cystic lesion. The present case describes a child with intramedullary cysticercosis who showed remarkable im- provement with albendazole under the cover of steroids with no adverse consequences. The debate of whether steroid worked or albendazole worked in our patient remains unanswered. This report in conjunction with the similar observation by other authors warrants re- * Jaya Shankar Kaushik jayashankarkaushik@gmail.com 1 Department of Pediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana 124001, India 2 Department of Pediatrics, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh 452001, India 3 Department of Radiodiagnosis, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana 124001, India Indian J Pediatr DOI 10.1007/s12098-017-2353-x