MR Imaging in intramedullary cysticercosis

Although intramedullary spinal cord cysticercosis (IMC) is uncommon, its pr esence is being increasingly recognised by magnetic resonance imaging. We s tudied six patients from an endemic region and present the MRI features and clinical correlation of IMC. Six patients who presented with para- or quad riplegia were studied by contrast enhanced spinal MRI. Prompted by the spin al lesions, all patients underwent brain MRI. Clinical data and laboratory studies were reviewed in all patients. Definite diagnosis was established i n the form of response to drug therapy (n = 4) and histopathology (n = 2). Follow-up MRI studies of spine and brain were obtained in four patients 2 m onths after they started medical treatment, regardless of surgery. Five pat ients showed fusiform and focal enlargement of the spinal cord (cervical 2, thoracic 3). Well-defined cysts with a slightly hyperintense mural nodule were identified in five patients in TI-weighted images (T1WI). All cysts we re hyperintense on T2WI and merged with the surrounding oedema. Oedema exte nded one to three vertebral levels above or below the cyst. Post-contrast T 1WI showed well-defined, ring enhancing lesions with smooth walls in all pa tients. Symptoms in all patients correlated with the level of the lesions. Brain studies demonstrated lesions in just two patients. Histopathological confirmation was obtained in two patients. Follow-up spinal MRI was normal in two patients, following 2 months of treatment while residual and smaller lesions were seen in two patients. Two patients were asymptomatic and deni ed follow-up MRI. MRI of spinal cysticercosis were typical of and similar t o those seen in cerebral lesions in our patients and corresponded to the le vel of symptoms. All cysts were surrounded by oedema. Two of four patients showed residual lesions after 2 months of therapy and 33 % of patients show ed concomitant intracranial lesions.