Isolated cysticercosis of the cauda equina
A 44-year-old housewife, born in Ecuador and otherwise healthy, was referred to us with a two years history of low back pain and left L5 radiculopathy complicated with more recent complaints of urinary incontinence and progressive paraparesis. Neurological examination disclosed muscle strength as grade — in both lower extremities with consensual diminished reflexes. Moreover, the patient presented hypoesthesia in the left L5 dermatome and saddle anesthesia. Magnetic resonance imaging (MRI) of the lumbar spine revealed two well-defined intradural cystic lesions, without contrast-enhancement, at L4-L5 level []. Our presumptive diagnosis was an intradural tumor of the cauda equina. This is why we did not perform any specific serologic or cerebrospinal fluid (CSF) tests. Therefore, the patient was subjected to L4-L5 laminectomy, but when the osteotomy was completed we had a surprise. The underlying dura appeared tough and tense with a spontaneous laceration in one point, through it a small cyst came out. After opening the dura the roots appeared tied up in bundle around two other lesions, not having been disclosed by preoperative MRI. By careful microsurgical dissection, the cystic masses were removed in toto, thanks to a clear cleavage plane []. The wound was irrigated with saline solution. The specimens were sent for histopathological analysis. Gross examination showed three transparent cysts and each one presented a small yellowish nodular area []. Histological examination demonstrated the cystic wall consisted of an outer cuticular layer with brush-like border, an epithelial-like intermediate layer, and an inner reticular layer made up of a canaliculi network. The scolex was not been identified []. Racemosus type of NCC was the final diagnosis. Post-operatively, the patient was treated with albendazole (15 mg/kg per day) for 4 weeks along with dexamethasone (4 mg\twice\daily for 1 week, then 4 mg per day for 10 days and every other day for 6 days). Clinically, the woman showed marked improvement in pain and motor strength, and a complete cranio-spinal MRI evaluation excluded any other cysticercosis lesions. The neuroradiologic follow-up studies, performed at 3, 6 months and 1-year after the operation [], demonstrated a complete resolution of the parasitic disease. The patient returned to her normal daily activities three months after the surgical procedure.