Present an uncommon manifestation of neurocysticercosis and demonstrate its potential prognosis with appropriate treatment

Neurocysticercosis is the most common parasitic infection of the brain. Endemic areas include sub-Saharan Africa, Latin America, and East and South Asia. Spinal involvement is uncommon (< 3% of cases) with intramedullary lesions being the least common.

A 60-year-old man with no significant past medical history presented to University Teaching Hospital in Zambia with 9 months of progressive lower extremity weakness and numbness and bowel/bladder incontinence. Neurologic exam demonstrated spastic paraplegia and mid-thoracic sensory level.  MRI without contrast showed a thoracic intramedullary cystic lesion as well as similar lesions in the subcutaneous tissues.  Albendazole, praziquantel, and prednisone treatment for spinal neurocysticercosis was initiated for two weeks with marked improvement of strength over time. At follow-up six months later, strength was 3-4/5 in all muscle groups with persistent spasticity and moderately improved sensory deficits.  He was able to ambulate short distances with a cane.

Intramedullary spinal neurocysticercosis may present with severe disability, but dramatic recovery is possible with appropriate diagnosis and initiation of therapy.  Subtle imaging findings, such as the presence of subcutaneous cysts as seen in this patient, can provide important clues to this diagnosis.  While thought to be rare, it is also possible that this form of neurocysticercosis is underdiagnosed due to limitations in spinal imaging and neurological expertise in many settings where this infection is common.