[Treatment of racemose neurocysticercosis of the spine]. / Tratamiento de la neurocisticercosis racemosa medular.

INTRODUCTION: Neurocysticercosis (NCC) is the most frequent parasitic infection of the central nervous system, and its prevalence is high in Portugal. Spinal involvement is rare, only occurring in between 1 and 5% of cases, and causes many problems when it comes to its diagnosis and treatment. Spinal leptomeningeal NCC is particularly difficult to treat, especially if associated to arachnoiditis. We report a case of NCC with spinal leptomeningeal involvement associated to extensive arachnoiditis, in which the therapeutic measures we have available today were totally ineffective. CASE REPORT: We describe the case of a 37-year-old male from Cape Verde, who was kept under surveillance because of a 3-month history of symptoms of cauda equina syndrome. In the last few months he also complained of holocranial headaches. Magnetic resonance (MR) imaging showed numerous cystic lesions in the bottom of the thecal sac, associated to extensive arachnoiditis, and MR images of the brain revealed compensated hydrocephalus. Diagnosis of NCC was confirmed by positive immunoblot in serum and in cerebrospinal fluid (CSF). Following insertion of a ventriculoperitoneal shunt, the patient received treatment with albendazole and corticoids for two weeks, and showed a clinical improvement. One year later, he showed symptoms of acute tetraparesis, and a cervical MRI showed cystic lesions with spinal cord compression and intense arachnoiditis. In spite of a decompression laminectomy, with removal of the cysts, and therapy with praziquantel and corticoids, the patient's clinical status did not improve. CONCLUSIONS: Spinal racemose NCC associated to arachnoiditis has a poor prognosis and is often untreatable. The therapeutic options in NCC of the spine are discussed, and attention is drawn to the importance of cysticercotic arachnoiditis in the prognosis of the disease.

What Makes Umbilical Cord Tissue-Derived Mesenchymal Stromal Cells Superior Immunomodulators When Compared to Bone Marrow Derived Mesenchymal Stromal Cells?

MSCs derived from the umbilical cord tissue, termed UCX, were investigated for their immunomodulatory properties and compared to bone marrow-derived MSCs (BM-MSCs), the gold-standard in immunotherapy. Immunogenicity and immunosuppression were assessed by mixed lymphocyte reactions, suppression of lymphocyte proliferation and induction of regulatory T cells. Results showed that UCX were less immunogenic and showed higher immunosuppression activity than BM-MSCs. Further, UCX did not need prior activation or priming to exert their immunomodulatory effects. This was further corroborated in vivo in a model of acute inflammation. To elucidate the potency differences observed between UCX and BM-MSCs, gene expression related to immune modulation was analysed in both cell types. Several gene expression profile differences were found between UCX and BM-MSCs, namely decreased expression of HLA-DRA, HO-1, IGFBP1, 4 and 6, ILR1, IL6R and PTGES and increased expression of CD200, CD273, CD274, IL1B, IL-8, LIF and TGFB2. The latter were confirmed at the protein expression level. Overall, these results show that UCX seem to be naturally more potent immunosuppressors and less immunogenic than BM-MSCs. We propose that these differences may be due to increased levels of immunomodulatory surface proteins such as CD200, CD273, CD274 and cytokines such as IL1ß, IL-8, LIF and TGFß2.

Characteristics of the gluteus medius muscle in an asymptomatic patient with radiographic signs of coxarthrosis.

This case study describes the micromorphology and some biochemical features of gluteus medius muscle in a 79-year-old woman with radiographic signs of coxarthrosis but with no clinical symptoms who initially was admitted in the orthopaedic emergency service with a non-displaced subcapital fracture of the femoral neck due to a domestic accident (fall). The X-ray of the hip showed some characteristic features of coxarthrosis, classified grade 2 of the Kellgren criteria. After informed consent, it was decided to carry out the functional evaluation according to the indexes of Lequesne and WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) and to take a biopsy of the gluteus medius muscle for microscopical examination and myosin heavy chain isoform identification during hip replacement surgery. For the Lequesne Index (score 0-24), the total score was 0, and for the WOMAC (score 0-96), the total score was also 0, both speaking in favour of full joint and muscle function. All the structural features observed in muscle were considered not to have any pathological relevance. The composition of the myosin heavy chains in the gluteus medius muscle was 48% MHC I, 41% MHC IIa, and 11% MHC IIx. The muscle characteristics do not support earlier concepts about muscle weakness as a predisposing factor for osteoarthritis. It is moreover concluded that the diagnosis should rather consider clinical symptoms than radiographic signs of osteoarthritis.

Tratamiento de la neurocisticercosis racemosa medular / Treatment of racemose neurocysticercosis of the spine

Introducción. La neurocisticercosis (NCC) es la infección parasitaria más frecuente del sistema nervioso central y cuenta con una elevada prevalencia en Portugal. La afectación medular es rara, se produce tan sólo entre el 1 y el 5% de los casos, y su diagnóstico y tratamiento ocasiona muchas dificultades. La NCC leptomeníngea medular es particularmente difícil de tratar, especialmente si se asocia a aracnoiditis. Describimos un caso de NCC con afectación leptomeníngea medular asociada a una extensa aracnoiditis, y en la cual las medidas terapéuticas de las que se dispone en la actualidad resultaron ineficaces. Caso clínico. Varón de 37 años, natural de Cabo Verde, al que se sometió a observación por presentar un cuadro de síndrome de cauda equina con progresión desde hacía tres meses. En los últimos meses se quejaba también de cefaleas holocraneales. La RM puso de manifiesto múltiples lesiones quísticas en el fondo del saco tecal, asociadas a una extensa aracnoiditis, y la RM encefálica reveló una hidrocefalia compensada. El diagnóstico de NCC se confirmó por inmunoelectrotransferencia en el suero y en el líquido cefalorraquídeo. Se le colocó una derivación ventriculoperitoneal, se le suministró albendazol y corticoides durante dos semanas, y experimentó una mejoría clínica. Un año después, presentó un cuadro de tetraparesia aguda, y la RM cervical mostró lesiones quísticas con compresión medular y aracnoiditis intensa. A pesar de la laminectomía descomprensiva con extirpación de los quistes, y la terapia con pracicuantel y corticoides, no se produjo ninguna mejoría en su estado clínico. Conclusiones. La NCC racemosa medular asociada a aracnoiditis presenta un mal pronóstico y es frecuentemente intratable. Se discuten las opciones terapéuticas en la NCC medular y se señala la importancia de la aracnoiditis cisticercótica en el pronóstico de la enfermedad

Introduction. Neurocysticercosis (NCC) is the most frequent parasitic infection of the central nervous system, and its prevalence is high in Portugal. Spinal involvement is rare, only occurring in between 1 and 5% of cases, and causes many problems when it comes to its diagnosis and treatment. Spinal leptomeningeal NCC is particularly difficult to treat, especially if associated to arachnoiditis. We report a case of NCC with spinal leptomeningeal involvement associated to extensive arachnoiditis, in which the therapeutic measures we have available today were totally ineffective. Case report. We describe the case of a 37-year-old male from Cape Verde, who was kept under surveillance because of a 3-month history of symptoms of cauda equina syndrome. In the last few months he also complained of holocranial headaches. Magnetic resonance (MR) imaging showed numerous cystic lesions in the bottom of the thecal sac, associated to extensive arachnoiditis, and MR images of the brain revealed compensated hydrocephalus. Diagnosis of NCC was confirmed by positive immunoblot in serum and in cerebrospinal fluid (CSF). Following insertion of a ventriculoperitoneal shunt, the patient received treatment with albendazole and corticoids for two weeks, and showed a clinical improvement. One year later, he showed symptoms of acute tetraparesis, and a cervical MRI showed cystic lesions with spinal cord compression and intense arachnoiditis. In spite of a decompression laminectomy, with removal of the cysts, and therapy with praziquantel and corticoids, the patient’s clinical status did not improve. Conclusions. Spinal racemose NCC associated to arachnoiditis has a poor prognosis and is often un-treatable. The therapeutic options in NCC of the spine are discussed, and attention is drawn to the importance of cysticercotic arachnoiditis in the prognosis of the disease