Abstract
Neurocysticercosis is an endemic infeccion in Brazil, but the intramedullary cases
are rare, 1,2% to 5,8% of all cases. There are only fifty cases reported until January
of 2011. Intramedullary neurocysticerosis is a treatable pathology but if misdiagnosed
it could lead to irreversible damage. Twenty eight year old female patient, previously
healthy, was admitted due to a fall. She had progressive walking difficulties and
impaired sensation in both lower limbs two months before admission. Contrast MRI revealed
a round intramedullary cystic lesion at T2 e T3. The patient underwent laminectomy
from T2 to T3, and the spinal cord was found locally swollen near the exit root at
this level. A mielotomy was performed where a round protrusion was seen near the root.
Histological examination of the resected sample showed cysticercosis. After surgical
excision she received albendazol and streoids. The patient's neurological function
postoperatively was unchanged. One week later, the motor power of her lower limbs
were grade 4/5, and she could walk without special support. The function of anal sphincter
and bladder regained without compromise. She was back to work. This reflects dramatically
in an active portion of population since it affects mostly people between 20 to 45
years. So it still represents a challenge and this paper intend to show our experience
and by that help future diagnostics.
Resumo
A neurocisticercose é uma doença endêmica no Brasil, mas os casos de lesão intramedular
são raros, representando 1,2% a 5,8% das neurocisticercoses. Há apenas 50 casos relatados
até 2011 na literatura. É uma patologia potencialmente tratável, mas erro diagnóstico
pode causar dano neurológico irreversível. Apresentamos um caso de paciente de 28
anos, previamente hígida, admitida após uma queda. Relatava fraqueza progressiva e
déficit sensitivo em membros inferiores com dois meses de evolução. Ressonância magnética
revelou lesão cística intramedular em T2-T3. A paciente foi submetida à laminectomia
T2-T3, com mietomia e ressecção de lesão cística completa. Exame histológico revelou
cisticercose. Realizaremos revisão da literatura com ênfase no diagnóstico e tratamento
da neurocisticercose medular, que podem representar um desafio ao neurocirurgião.
Keywords
Neurocysticercosis - spinal cord - cysticercosis/terapy
Palavras-chave
Neurocisticercose - medula espinal - cisticercose/terapia
