RESUMO
We report a 16 year old male patient from rural Ethiopia with pathologically and intraoperatively proven thoracic para spinal and epidural hydatidosis, a very rare involvement, who presented with progresive both lower limb weakness, loss of pain, touch and properioception and double incontinence of two weeks prior to hospital admission. The pathological, radiological (MRI and plain x-ray) and the intra operative findings are briefly discussed with literature review.
Assuntos
Equinococose/diagnóstico , Espaço Epidural/parasitologia , Paraparesia/parasitologia , Paraplegia/parasitologia , Doenças da Coluna Vertebral/parasitologia , Vértebras Torácicas/parasitologia , Adolescente , Etiópia , Incontinência Fecal/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Doenças da Coluna Vertebral/diagnóstico , Incontinência Urinária/etiologiaAssuntos
Equinococose/complicações , Canal Medular/parasitologia , Compressão da Medula Espinal/parasitologia , Espaço Subdural/parasitologia , Criança , Pré-Escolar , Descompressão Cirúrgica , Dura-Máter/parasitologia , Dura-Máter/cirurgia , Equinococose/patologia , Equinococose/cirurgia , Feminino , Humanos , Laminectomia , Masculino , Procedimentos Neurocirúrgicos , Paraparesia/parasitologia , Paraparesia/cirurgia , Polirradiculopatia/parasitologia , Polirradiculopatia/cirurgia , Canal Medular/cirurgia , Compressão da Medula Espinal/terapia , Espaço Subdural/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: Spinal hydatid cyst is a serious form of hydatid disease affecting fewer than 1% of all patients with hydatid disease. We report 3 healthy patients who presented with progressive paraparesis attributed to a histologically proven intradural hydatid cyst. METHODS: There were 2 children (1 boy, 1 girl) and 1 adult with a mean age of 12 years. The median follow-up duration was 16 months. Spinal magnetic resonance imaging was performed in the 3 patients, and an anatomic and topographical diagnosis of the intradural hydatid cyst was made. RESULTS: Magnetic resonance imaging scans revealed cystic lesions with peripheral contrast enhancement. Surgery was performed through laminectomy, complete resection was achieved, and antihelminthic treatment with albendazole 10 mg/kg-1 per day for 6 months was included in the postoperative treatment. The patients improved after surgery with normal motor function. CONCLUSION: This localization is rare and serious, but its prognosis is excellent if diagnosis is made early enough and surgery is performed in time to prevent cyst rupture.
Assuntos
Equinococose/complicações , Canal Medular/parasitologia , Compressão da Medula Espinal/parasitologia , Espaço Subdural/parasitologia , Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Criança , Pré-Escolar , Descompressão Cirúrgica , Dura-Máter/parasitologia , Dura-Máter/patologia , Dura-Máter/cirurgia , Equinococose/patologia , Equinococose/cirurgia , Feminino , Humanos , Laminectomia , Imageamento por Ressonância Magnética , Masculino , Procedimentos Neurocirúrgicos , Paraparesia/parasitologia , Paraparesia/patologia , Paraparesia/cirurgia , Polirradiculopatia/parasitologia , Polirradiculopatia/patologia , Polirradiculopatia/cirurgia , Canal Medular/patologia , Canal Medular/cirurgia , Medula Espinal/patologia , Medula Espinal/fisiopatologia , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/terapia , Raízes Nervosas Espinhais/parasitologia , Raízes Nervosas Espinhais/patologia , Raízes Nervosas Espinhais/cirurgia , Espaço Subdural/patologia , Espaço Subdural/cirurgia , Vértebras Torácicas/parasitologia , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
Hydatid disease is caused by the larval form of Echinococcus. Lung and liver are the most commonly affected sites. Primary intradural extramedullary hydatid disease is extremely rare; a 13-year-old girl with primary intradural hydatid cyst who presented with symptoms of paraparesis is discussed in this article.
Assuntos
Equinococose/parasitologia , Paraparesia/parasitologia , Doenças da Coluna Vertebral/parasitologia , Adolescente , Albendazol/uso terapêutico , Antiprotozoários/uso terapêutico , Equinococose/diagnóstico , Equinococose/tratamento farmacológico , Equinococose/cirurgia , Feminino , Humanos , Laminectomia , Imageamento por Ressonância Magnética , Paraparesia/diagnóstico , Medula Espinal/patologia , Doenças da Coluna Vertebral/tratamento farmacológico , Doenças da Coluna Vertebral/cirurgiaAssuntos
Neuroesquistossomose/diagnóstico , Neuroesquistossomose/fisiopatologia , Medula Espinal/patologia , Medula Espinal/parasitologia , Raízes Nervosas Espinhais/patologia , Raízes Nervosas Espinhais/parasitologia , Adulto , África , Anti-Helmínticos/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Cauda Equina/parasitologia , Cauda Equina/patologia , Cauda Equina/fisiopatologia , Diagnóstico Diferencial , Eosinofilia/parasitologia , Humanos , Masculino , Pessoa de Meia-Idade , Neuroesquistossomose/tratamento farmacológico , Paraparesia/parasitologia , Paraparesia/patologia , Paraparesia/fisiopatologia , Praziquantel/administração & dosagem , Prednisolona/administração & dosagem , Transtornos de Sensação/parasitologia , Transtornos de Sensação/patologia , Transtornos de Sensação/fisiopatologia , Medula Espinal/fisiopatologia , Compressão da Medula Espinal/parasitologia , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/fisiopatologia , Raízes Nervosas Espinhais/fisiopatologia , Viagem , Resultado do Tratamento , Incontinência Urinária/parasitologia , Incontinência Urinária/patologia , Incontinência Urinária/fisiopatologiaRESUMO
The authors report a case of cauda equina compression by intradural hydatid cyst. An 18-year-old man presented with paraparesis and sphincter dysfunction. MRI showed an intradural cystic lesion extending from L1 to L2 with low signal intensity on T1 and high signal intensity on T2. The cyst was removed after laminectomy and opening of the dural sac. Histological and parasitic examinations confirmed a diagnosis of hydatid cyst. The patient improved progressively after surgery. The similar 22 cases of intradural extramedullary hydatid disease reported in the literature were reviewed. All spinal areas were involved, with a predilection for the thoracic region. Neurological complications were usual with rapid spinal cord compression in this rare form of hydatid disease. The treatment was by surgery with a favourable outcome compared to the classic hydatid cyst of the spine.
Assuntos
Equinococose/diagnóstico , Doenças da Medula Espinal/diagnóstico , Adolescente , Cauda Equina , Descompressão Cirúrgica , Equinococose/complicações , Equinococose/cirurgia , Humanos , Laminectomia , Imageamento por Ressonância Magnética , Masculino , Marrocos , Síndromes de Compressão Nervosa/parasitologia , Paraparesia/parasitologia , Compressão da Medula Espinal/parasitologia , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/cirurgia , Resultado do TratamentoRESUMO
INTRODUCTION: The trematode infection schistosomiasis affects at least 200 million people in endemic areas. Granulomas cause the typical manifestations of urogenital, intestinal and hepatolienal schistosomiasis. Involvement of other organs especially the central nervous system (CNS) is uncommon. CASE REPORT: We describe a 40-year old male with a history of repeated contact with schistosome contaminated water. After having suffered from flu-like symptoms with fever and arthralgias, he first presented with a polyradiculopathy of unknown origin. Then 4 weeks later an acute tetraparesis occurred. Spinal magnetic resonance imaging (MRI) revealed a spinal stenosis and query medullary hyperintensities at C6-C8 without contrast-enhancement. Serologic testing was positive for schistosomiasis. The intraoperative appearance at decompressive laminectomy revealed a myelitic form of schistosomiasis. Under therapy with praziquantel, initially high dose cortisone and intensive physiotherapy, symptoms slowly improved over months. On follow-up 1 year later, the patient presented with a spastic distally marked tetraparesis and sensory impairment from C6 downwards. CONCLUSION: Cervical intramedullar schistosomiasis is a rare cause of acute tetra- or para-paresis in patients, who have had contact with schistosomes. Early diagnosis is essential because of the excellent prognosis with specific therapy.