cysticercosis , caused by encysted larva of taenia solium , is the most common parasitic infestation of the central nervous system , but spinal cysticercal infection is relatively rare with the incidence reported as only 0.75.85% . majority of the reported cases of intramedullary cysticercosis ranged in age between 20 and 45 years and the condition is very rare in the pediatric age group . although surgery is the mainstay of treatment , magnetic resonance imaging ( mri ) can help in preoperative diagnosis , thus avoiding the high morbidity and mortality associated with the surgery . we hereby report a case of a 10-year - old female patient with isolated intramedullary cysticercosis , who responded dramatically to medical treatment . a 10-year - old female patient presented with gradual weakness in both lower limbs and numbness from lower thorax to foot for 3 months . neurological examination revealed spastic paraplegia ( motor power 3/5 ) , brisk b / l deep tendon reflexes with extensor plantar and loss of sensations to pinprick bilaterally below t5 dermatomes . contrast - enhanced mri of the spine revealed an isolated , well - defined , intramedullary cystic lesion measuring 1.8 1.0 cm at the level of d2 vertebral body . on t1-weighted imaging , the lesion was hyperintense on t2-weighted image with an isointense mural nodule [ figure 1b and c ] . csf examination done revealed elevated protein and normal glucose levels with increased lymphocytes , and few eosinophils and positive enzyme - linked immunosorbent assay ( elisa ) for anti - t . ( b ) sagittal and ( c ) axial t2-weighted images showing a well - defined cystic hyperintense lesion with isointense mural nodule ( scolex ) opposite d2 vertebrae associated with adjacent cord edema . ( d ) contrast - enhanced mr images showing peripheral enhancement of lesion keeping the provisional diagnosis of cysticercosis in mind , empirical treatment with antihelminthic along with steroids was started . marked clinical improvement was seen within a few days in the form of increase in limb power and return of tendon reflexes . cysticercosis is endemic in most of the developing countries like brazil , mexico , korea and south asian countries . intramedullary cysticercosis is rare even in endemic areas , with an incidence reported between 0.7% and 5.85% . four forms of spinal neurocysticercosis have been identified : vertebral , extradural , intradural extramedullary and intramedullary , the commonest being intradural extramedullary region . extramedullary form occurs due to csf dissemination ( ventriculo ependymal migration ) of focus in brain , whereas intramedullary forms result due to hematogeneous spread of the parasitic larvae . intramedullary cysticercosis is most common in the thoracic spine due to high vascularity of this spinal segment . neurological manifestations can be produced by the parasite itself causing mechanical compression and obstruction , surrounding inflammation , cord edema and residual scarring , pachymeningitis or syrinx formation . usual mr findings include a cystic lesion with signal intensity similar to csf on t1-weighted and t2-weighted mri . a mural nodule , which represents the scolex , appears isointense or hyperintense on t1-weighted mri and reverse on t2-weighted mri . the thickened capsule is hyperintense on t1 wi and hypointense on t2 wi.[57 ] the role of mri in the diagnosis of neurocysticercosis is well documented . it helps not only in the diagnosis but also in the preoperative localization of the lesion and the extent of involvement . mri findings in neurocysticercosis can be non - specific , especially when scolex is not seen and the differentials for an intramedullary cystic lesion include hydatid cyst , dermoid cyst , post - traumatic syrinx , metastases and granulomatous diseases . but the presence of scolex and history of origin from endemic area enables differentiation from other disease processes . csf examination in patients with neurocysticercosis usually reveals moderate lymphocytic pleocytosis , variable eosinophilic pleocytosis , elevated protein , and low / normal glucose levels . surgery can eliminate the compressive element , especially in patients presenting with acute onset of symptoms , and in cases wherein the diagnosis is doubtful , surgical excision should be done . however , operative mortality is reported to be 15% and the morbidity is reported to be 85% , but excellent results can be obtained with microneurosurgery . based on mri findings , some authors now recommend the use of antihelminthic drugs along with steroids without resorting to surgery . treated their patients with drug therapy for 75 days and found that intramedullary cysticercosis resolved completely in a patient who was on albendazole treatment for cerebral neurocysticercosis . found that out of four patients in his series , two reported complete resolution of the cyst on mri , and marked clinical improvement was seen in all the four patients . ahmad et al . reported successful treatment of a case of intramedullary cysticercosis with a 2-week course of medical therapy . ahmad et al . reported achievement of cure within 2 weeks ; however , some authors suggest 48 weeks treatment . our patient was treated with albendazole and steroids for 4 weeks and showed marked clinical improvement . isolated cysticercosis of spine is difficult to suspect ; however , correlation of clinical findings , history of endemic area origin and typical mri findings can help in making the diagnosis , thus obviating the need for surgery which is associated with high morbidity and mortality .