it is quite uncommon lesion. The case has presented with numbness bit unusual symptom for neurocysticercosis.

1. DR REKHA KHARE
MD RADIOLOGY

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

3.  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

4.  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

10.  Contrast MRI shows:
A Ring enhanced lesion with central
enhanced nidus and moderate
perilesional oedma
 Minimal focal syrinx at the level of lesion

11.  Ring enhanced lesion: commonest
Tuberculoma and Neurocysticercosis
 Other Intramedullary cystic lesion:
infection/ abscess,
arachnoid cyst,ependymal cyst,
neurentric cyst, sarcoidosis,neoplasm

12.  Our case was straight forward case of
Intramedullary 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

13.  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

14.  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

15.  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

16.  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

17.  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

18.  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

19. 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

20.  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

21.  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

22.  Bin Qi,Pengfei Ge, Hongfa Yang, Chunhua Bi and
YipingLi. Spinal Intramedullary Cysticercosis: A
case Report and Literature Review: Int J Med Sci
2011;8(5)420-423
 Kumar S, Handa A, Chavda S. et al.
Intramedullary cysticercosis. J Clin
Neurosci.2010;17(4): 522-3[pub med]
 Lt Col PK Sahoo. Spinal Intramedullary
Cysticercosis.MJAFI2000,56:240-241
 Mathuria SN, Khosla VK, Vasistha RK et al
Intramedullary cysticercosis;MRI diagnosis.Neurol
India.2001;49(10: 71-4[pub med]

23.  Shubhangi V Agale, Shweta Bhavsar and Vidhya
Manohar: Isolated intramedullary spinal cord
cysticercosis. Asian J Neurosurg.2012 Apr-
Jun;7(2):90-92
 Singh p, Sahai K. Intramedullary cysticercosis.
NeurolIndia 2004:52:264-5(pub Med)
 Taveras JM,Wood Eh. Diagnostic neuro radiology.
2nd
ed.Baltimore The Williams and Wilkins
company 1977:1162

24. HAVE A NICE DAY