[Pure spinal cysticercosis. Note on the cerebrospinal fluid]

Area of Science:

• Neurology
• Infectious Diseases
• Parasitology

Background:

• Cysticercosis, a parasitic infection caused by the larval cysts of the tapeworm Taenia solium, can affect various organs, including the central nervous system.
• Spinal cysticercosis is a rare manifestation, often presenting with symptoms mimicking other spinal cord pathologies.

Observation:

• A patient from Benin presented with progressive bilateral sciatic pain and sensorimotor deficits in the lower limbs.
• Symptoms evolved to include thoracic spinal cord compression, with myelography revealing numerous intrathecal cysts from the cauda equina to the cervical cord.
• Cerebrospinal fluid (CSF) analysis demonstrated eosinophils, elevated protein levels, and local synthesis of immunoglobulin G with an oligoclonal profile.

Findings:

• Diagnosis of cysticercosis was confirmed by examining cysts obtained during lumbar laminectomy.
• Accidental cyst puncture showed cerebrospinal fluid with protein migration and local immunoglobulin A synthesis.
• Treatment with Praziquantel was ineffective in resolving the parasitic cysts or improving neurological symptoms.

Implications:

• This case underscores the potential for extensive spinal involvement in neurocysticercosis, presenting diagnostic challenges due to its rarity and varied presentation.
• The findings highlight the importance of considering cysticercosis in endemic regions, even with atypical neurological symptoms.
• The ineffectiveness of Praziquantel suggests potential limitations in current treatment protocols for severe or disseminated spinal cysticercosis, warranting further research into alternative therapeutic strategies.