Aman Agarwal, Rohin Bhatia, Bhawani Shankar Sharma
An 18-year-old male patient reported in neurosurgery OPD of Mahatma Gandhi National Institute of Medical Sciences, Jaipur (MGM Hospital) with progressive weakness in bilateral upper and lower limb since 20 days. Patient also complained of difficulty in walking since 10 days. Increased tendon reflexes, spasticity in both upper and lower limbs with more spasticity in upper left limb. Sensations were intact. Left hand grip was weak and Hoffman’s sign was positive. Extensor Hallucis Longus weakness found was more in left lower limb. Ankle and Patellar Clonus was present. Babinski sign was found to be positive. Contrast Enhanced MRI spine revealed an expansile ill-defined intramedullary mass of cervical cord centered opposite C3 and C4 vertebral level. Lesion was isointense on T1WI and has complex hypointense and hyperintense signals on T2WI. No such lesion was found at thoracic or lumbar levels. Also, MRI brain screening revealed no abnormalities. Surgery was necessary for the progressive neurological deterioration of patient. The patient reported to us had no history of neurocysticercosis but belonged to endemic region, so we could clinically suspect intramedullary cysticercosis prior to the treatment. India is one of the endemic regions for cysticercosis.1,2 The common clinical signs include pain, paraparesis, spasticity, bowel and bladder incontinence and sexual dysfunction, depending on following the factors: lesion level on spine, anatomical location (extradural/extramedullary /intramedullary), lesion size, stage of development of cysticerci and host immune reaction. In cases of extramedullary lesions, most common symptoms are of back pain and radicular pain whereas in spinal cord compression cases with intramedullary lesions, the most common clinical signs are myelopathy and progressive weakness. The patient showed progressive weakness in limbs with spasticity in both upper and lower limb with more spasticity in upper left limb.
