DR REKHA KHARE MD RADIOLOGY

A young man was referred from neurology OPD for MRI cervical spine with the complaints of numbness of left arm, for last six months

Neurological exam. revealed normal higher mental and cranial nerve function

No motor power loss is noticed in left arm, grip was normal

X-ray cervical spine - AP and Lateral view shows nothing significant

Routine Lab examination was found with in normal limit

All standard sequences were taken Non contrast MRI revealed an relatively well

defined cystic nodular intramedullary hypo intense lesion on T1W1 sequence with hyper intense nidus lesion in the center at

C2-3 level Lesion gets hyper intense on T2 W1

sequence with mild hyper density in surrounding area

Contrast MRI shows: A Ring enhanced lesion with central enhanced nidus and moderate perilesional oedma

Minimal focal syrinx at the level of lesion

Ring enhanced lesion: commonest Tuberculoma and Neurocysticercosis

Other Intramedullary cystic lesion: infection/ abscess,

arachnoid cyst,ependymal cyst,

neurentric cyst, sarcoidosis,neoplasm

Our case was straight forward case ofIntramedullary Cysticercosis – Ring enhanced lesion with pin

point dot calcification in the center and oedma in surrounding tissue** focal syrinx could be the possible reason

of the only symptom of Numbness

Cysticercosis is a parasitic disease caused by larval stage of Taenia solium

Cysticercosis in human is first described in 1550 by Pranoli

Cysticercosis is endemic in Indian subcontinent

Commonly cysticercosis occurs due to either ingestion of contaminated vegetables, eaten raw or oral-faecal route

Disease is not restricted to the pork eater who usually harbour the adult parasite

Cysticercosis CNS is common in poor developing region esp. in pediatric age group

Incidence of neurocysticercosis is about 4% of the general population

Isolated Spinal intramedullary cysticercosis

is quite rare compared to spinal subarachnoid cysticercosis

It has been described very little. The proposed mechanism of spread is hematogenous dissemination

As thoracic cord receives maximum blood so it is most commonly affected

Most Possible pathogenesis through ventriculo-ependymal spread by migration of larva from ventricle along CSF down to spinal subarachnoid space

Majority of cysticerci can not pass through the subarachnoid space at the cervical level due to its size and physiological sieve

Cyst may increase with in cord and so produce symptoms like that of small syrinx

Toxic effects include local inflammation secondary to leakage of parasitic metabolic by product with in the cyst fluid

Vascular compromise secondarily results in cord ischemia and myelomalacia

Tuberculoma Irregular in shape Solid Ring enhanced

lesion more than 2cm

Severe perilesional oedma with mass effect/ focal neurological deficit

TB else where

Neurocysticercosis Round Cystic Ring enhanced

lesion less than 2cm with visible scolex/nidus.. Target lesion

Perilesional oedma not enough to produce mass effect

Intramedullary cysticercosis represents a diagnostic challenge

TARGET LESION: Ring enhanced small lesion with pin point dense center/scolex and usually with mild perilesional oedma is quite characteristic

it should be strongly considered in low socio- economic poor developing area

Major cause of adult onset Epilepsy in the developing world CNS and eye involvement is termed as

Neurocysticercosis Predilection for migration to eyes, CNS and striated

muscle probably due to increased glycogen and glucose content of these tissue

Radiological staging: visible cyst with scolex

degenerating cyst calcified cyst

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