[Micturition dysfunction triggered by spinal intramedullary neurocysticercosis]

Neurocysticercosis is the most common parasitic disease of the human nervous system. This case report describes the rare intramedullary form of spinal neurocysticercosis.

A 26-year-old male patient demonstrated sinistral brachialgia, arm paralysis and progressive disturbance of micturition with a weak urine stream and persisting residual urine. The cervical MRI revealed a large intramedullary space-occupying lesion in the spinal cord, which was excised. Histologically, parasitic structures were detected and the lesion classified as neurocysticercosis. Retrospectively, more detailed evaluation of the patient's medical history disclosed a number of subtle early neurological symptoms of the disease. The infection was probably acquired during a stay in South America 20 years earlier. The MRI revealed additional multiple small intramedullary lesions and a large lesion in the area of the conus medullaris, which could not be excised. The clinical course was partially dramatic and eventually resulted--apart from small neurological deficits--in complete failure of micturition due to a hyposensible, hypercontractile and instable detrusor muscle. In order for the patient to empty his bladder, sterile single catheterization under anticholinergic medication became necessary.

Diagnosis of neurocysticercosis on clinical grounds is difficult, especially in regions like Europe, where the disease is very rare. In patients with non-specific neurological symptoms, and radiological indication of an intraspinal tumor, a history of stays in endemic regions even a long time ago, neurocysticercosis should be considered in the differential diagnosis as a possible cause.