Intradural extramedullary cysticercal abscess of spine
A 38-year-old female patient came with complaints of insidious onset, slowly progressing back pain with pain radiating anteriorly to abdomen of one week duration associated with weakness and numbness of both lower limbs. Her bowel and bladder were normal. On examination she had bilateral lower limb paresis of 4/5 (MRC Medical Research Council grading) and decreased sensations below L2 dermatome. The lumbosacral spine magnetic resonance imaging (MRI) showed a mixed intensity, intradural extramedullary lesion at D12-L1 level measuring about 11.4 × 11.2 × 22.8 mm displacing the conus and cauda with heterogenous enhancement with contrast []. She underwent D12-L1 laminectomy, biopsy, debulking, and decompression of the cord. Intraoperatively there was evidence of group of dilated vessels which were followed into a lesion that appeared to be like schwannoma at some areas and epidermoid at other areas. A major portion of lesion was dissected. At the cranial end of the lesion there was a sudden gush of yellowish pultaceous material and a diagnosis of inflammed epidermoid was made intraoperatively. Histopathology showed a well-formed abscess adjacent to which a cystic structure was thrown into folds. Close up view of the abscess showed fibrocollagenous wall and dense aggregates of large foamy histiocytes admixed with lymphocytes. The cystic structure revealed wall of cysticercal cyst with outer well preserved undulating tegumentary layer with inner zone of subtegumentary cytons and loose reticular layer with excretory/secretory ductules. No scolex was identified []. Culture of the cyst content was negative for bacterial growth. A final diagnosis of cystericercal abscess was made. Post-operatively she was given a course of albedazole and steroids for a period of 8 weeks. She had relief from her back pain and had improvement in her paresis. At a follow up period of 8 months she has no neurological deficits.