"Malignant" Craniospinal Neurocysticercosis: A Rare Case

Abstract

Background: Neurocysticercosis (NCC) is the commonest parasitic infection of the central nervous system. There is significant difference in incidence of NCC depending on geographic location, and incidence as high as 4% is reported in the endemic areas. It results from human affliction by the larval stage of Taenia solium. Spinal NCC is quite rare as compared with cranial NCC and accounts for 1.5%-3% of all cases. Both spine and cranium can be rarely involved in NCC, and cranial involvement usually precedes the spinal involvement.

Case description: We report a case of a 51-year-old woman who had spinal involvement first in the form of spinal intradural extramedullary disease and then developed cranial involvement more than 1 year later. She developed spinal arachnoiditis. She developed communicating hydrocephalous requiring ventriculoperitoneal shunt. Later she developed isolated fourth ventricle and required excision of the fourth ventricular NCC. The unique aspects of our patient were a very aggressive course and involvement of cranium after spinal involvement. We describe her clinical course over 3 years and the management done.

Conclusions: NCC can sometimes follow a very aggressive course and can involve both cranial and spinal compartments. Management of such patients is not standardized given the rarity of such cases.

Keywords: Arachnoiditis; Craniospinal; Hydrocephalous; Intradural; Intraventricular; Neurocysticercosis.