INTRAMEDULLARY CYSTICERCOSIS CURED WITH DRUG-TREATMENT - A CASE-REPORT

Study Design. A report of a patient with cervical intramedullary cysti cercosis is presented. Objectives. To report the first case of intrame dullary cysticercosis cured with drug management only, which supports the hypothesis that management with anthelmintics might be successfull y used in this form of cysticercosis. Summary of Background Data. Intr amedullary cysticercosis is a rare manifestation of neurocysticercosis . Every treated patient reported to date has undergone surgery, freque ntly necessary for diagnosis. Since the anthelmintics praziquantel and albendazole were shown to be effective in parenchymal brain cysticerc osis, these drugs have been considered potentially useful in patients with intramedullary cysticercosis. Nevertheless, no case yet had been reported to be cured with only medical therapy. Methods. The treatment of a patient who suffered multiple cysticercal reinfestations of the nervous system is presented. Results. The patient received prolonged t reatment with albendazole because of superimposed cerebral reinfestati ons. During this treatment, she suffered acute paraparesis, and cervic al magnetic resonance imaging showed cyst-like lesions with linear gad olinium enhancement and perilesional edema, indicative of dying cystic erci and inflammatory host reaction. Dexamethasone was added, and prog ressive neurologic improvement followed with complete resolution of in tramedullary lesions. Conclusions. A preoperative diagnostic suspicion of cysticercosis is important in patients with intramedullary cystic lesions because specific drug treatment is available. Treatment with a nthelmintics, particularly albendazole, should be considered in patien ts with intramedullary cysticercosis before surgery. Corticosteroids m ay be added to the therapeutic regimen because this may reduce the per ilesional edema and prevent neurologic deterioration during the course of anthelmintic treatment.