J Korean Neurosurg Soc.  2014 Apr;55(4):226-229. 10.3340/jkns.2014.55.4.226.

A Case of Intradural-Extramedullary Form of Primary Spinal Cysticercosis Misdiagnosed as an Arachnoid Cyst

• Yoo M
• Lee CH
• Kim KJ
• Kim HJ

• KMID: 2191099
• DOI: http://doi.org/10.3340/jkns.2014.55.4.226

Abstract

We describe a rare case of intradural-extramedullary primary spinal cysticercosis. A 42-year-old man visited our institute for lower back pain. He denied having consumed raw meet. Magnetic resonance (MR) images revealed an intradural pure cystic mass at the L3-L4 level. A radiologic diagnosis of spinal arachnoid cyst was established. Three years later, he complained of aggravated back pain, and follow-up MR examination showed a markedly expanded cyst, occupying the subarachnoid space from the T11 to the S1 level. L2 hemilaminectomy was performed, and a yellowish infected cyst bulged out through the dural opening. The cyst was removed en bloc. The histopathological findings of the cyst were consistent with parasitic infection. Serum enzyme-linked immunosorbent assay (ELISA) confirmed the presence of spinal cysticercosis. As there was no intracranial lesion, the final diagnosis was primary spinal cysticercosis, which is very rare. MR imaging is a sensitive diagnostic tool for detecting cystic lesions in the spine; however, it is difficult to distinguish cysticercosis from non-infectious cysts such as an arachnoid cyst without using gadolinium enhancement. Clinicians treating spinal cysts with an unusual clinical course should include cysticercosis as a differential diagnosis. We recommend contrast-enhanced MR imaging and serum ELISA in the diagnostic work-up of such cases.

Keyword

Neurocysticercosis; Primary spinal cysticercosis; Taenia solium

MeSH Terms

Adult
Arachnoid*
Back Pain
Cysticercosis*
Diagnosis
Diagnosis, Differential
Enzyme-Linked Immunosorbent Assay
Follow-Up Studies
Gadolinium
Humans
Low Back Pain
Magnetic Resonance Imaging
Neurocysticercosis
Spine
Subarachnoid Space
Taenia solium
Gadolinium

Figure

• 

  Fig. 1 Magnetic resonance imaging of the lumbar spine : Sagittal T2-weighted image showing an intradural cystic lesion (arrow) that is well circumscribed at the L3-L4 level (A). Three years later, follow-up sagittal (B) and axial (C) T2-weighted images of the L2 level reveal that the cyst (arrow) has grown, and occupies the T11-S1 levels. Post-operative images showing that the spinal cysticercosis has been removed without remnants (D).

• 

  Fig. 2 Intraoperative photographs showing the cystic lesion observed after opening the dura (asterisk). The removed cyst was an oval-shaped yellowish lesion.

• 

  Fig. 3 Photomicrograph of the specimen showing a translucent cyst wall with eosinophilic lining (black arrows), and chronic inflammatory cells (Hematoxylin & Eosin, original magnification ×100).

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