Herniated lumbar disc combined with spinal intradural extramedullary cysticercosis

Abstract

Spinal cysticercosis is a very uncommon manifestation of neurocysticercosis which is caused by the larvae of Taenia solium. However, it can develop as a primary infection through blood stream or direct larval migration. It can result in high recurrence and severe neurologic morbidity if not treated appropriately. We report the case of a 43-year-old woman who presented with severe lower back pain and left leg radiating pain in recent 2 weeks. Magnetic resonance image (MRI) of lumbar spine demonstrated extruded disc at the L5-S1 level combined with intradural extramedullary cystic lesion. We performed the open lumbar microdiscectomy (OLM) at L5-S1 on the left with total excision of cystic mass. After surgery, the patient showed an improvement of previous symptoms. Diagnosis was confirmed by histopathological examination as intradural extramedullary cysticercosis. We discuss clinical features, diagnostic screening, and treatment options of spinal cysticercosis.

Keywords: Cysticercosis; Intradural cysticercosis; Neurocysticercosis; Spinal cysticercosis; Taenia solium.

Fig. 1

A : Preoperative sagittal T1- and T2-weighted images show the downward extruded disc at L5-S1 combined with cystic lesion (arrow), which is isointense on T1- and hypointense on T2-weighted images. B : Preoperative axial T2-weighted images show a cystic lesion at the spinal intradural extramedullary location.

Fig. 2

Surgical excision of the extramedullary cyst. A : Intraoperative finding of grape-like, multiple whitish small masses within the cyst. B : Photograph of the operative specimen at the operating room.

Fig. 3

Photomicrograph of the histopathological specimen revealing the scolex (arrow) and a portion of the cyst wall (arrow head) (H&E, original magnification ×40).

Fig. 4

T2-weighted MRI 1 week later after surgery shows well-decompressed herniated disc and total excision of cystic mass.