[An adolescent with lumbosacral instability due to the presence of a hydatid cyst: a case report]. / Adolescente con inestabilidad lumbosacra por presencia de quiste hidatídico: reporte de caso.

Hydatidosis, caused by Echinococcus granulosus, affects the spinal column in 0.5-2% of all cases, with the sacral column being a rare location typically observed only in adults. The case is reported of a 14-year-old boy from Juliaca (Puno, Peru) who presented with chronic lower back pain and cauda equina syndrome. He was initially attended to in Juliaca, and then transferred to the Hospital Edgardo Rebagliati Martins (Lima, Peru) with a diagnosis of sacral tumor. In magnetic resonance imaging, a multicystic tumor was seen with L5 and S1 lysis and instability. The surgical treatment was an L5- S2 laminectomy and extraction of multiple hydatid cysts followed by lumbopelvic stabilization with transpedicular screws. Post-operatively, he was prescribed albendazol (15 mg/kg/d) for six months. Hydatid cysts should be considered within the differential diagnosis when there are cystic lesions in the spinal column, particularly in endemic areas such as Peru.

Adolescente con inestabilidad lumbosacra por presencia de quiste hidatídico: reporte de caso / An adolescent with lumbosacral instability due to the presence of a hydatid cyst: a case report

RESUMEN La hidatidosis, causada por el Echinococcus granulosus, afecta a la columna vertebral en 0,5-2% del total de casos, siendo la columna sacra una ubicación rara, típica de personas en edad adulta. Se reporta el caso de un varón de 14 años oriundo de Juliaca (Puno, Perú) quien presentó lumbalgia crónica y síndrome de cauda equina. Atendido inicialmente en Juliaca, fue trasladado al Hospital Edgardo Rebagliati Martins (Lima, Perú) con el diagnóstico de tumoración sacra. En la resonancia magnética se mostró una tumoración multiquística con lisis del L5 y S1 e inestabilidad. El tratamiento quirúrgico fue una laminectomía L5-S2 y extracción de múltiples quistes de hidátide más estabilización lumbopélvica con tornillos transpediculares. En el posoperatorio se recetó albendazol (15 mg/kg/d) por el periodo de seis meses. Se debe considerar al quiste hidatídico dentro del diagnóstico diferencial cuando existan lesiones quísticas en la columna vertebral, sobre todo en regiones endémicas como el Perú.

ABSTRACT Hydatidosis, caused by Echinococcus granulosus, affects the spinal column in 0.5-2% of all cases, with the sacral column being a rare location typically observed only in adults. The case is reported of a 14-year-old boy from Juliaca (Puno, Peru) who presented with chronic lower back pain and cauda equina syndrome. He was initially attended to in Juliaca, and then transferred to the Hospital Edgardo Rebagliati Martins (Lima, Peru) with a diagnosis of sacral tumor. In magnetic resonance imaging, a multicystic tumor was seen with L5 and S1 lysis and instability. The surgical treatment was an L5- S2 laminectomy and extraction of multiple hydatid cysts followed by lumbopelvic stabilization with transpedicular screws. Post-operatively, he was prescribed albendazol (15 mg/kg/d) for six months. Hydatid cysts should be considered within the differential diagnosis when there are cystic lesions in the spinal column, particularly in endemic areas such as Peru.

Myeloradiculopathy associated to Schistosoma mansoni.

Neuroschistosomiasis caused by Schistosoma mansoni (Sm) is a rare and severe condition potentially leading to permanent neurological deficit. An 18-year-old Brazilian female was admitted due to a severe conus medullaris and cauda equina syndrome. MRI of thoracic/lumbar spine showed an expanded conus medullaris with patchy gadolinium-enhancement, needle electromyography revealed acute bilateral radiculopathy (L5-S1-S2), cerebrospinal fluid (CSF) showed lymphocytosis and increased proteins and lesion' surgical biopsy documented a lymphocyte infiltrate. Immunodiagnosis with cercariae hullen reaction using Sm cercariae in CSF and serum and immunoelectrodiffusion for circulating antigens detection using anti-Sm antibodies were positive. No schistosoma parasites were found. The patient was treated with praziquantel and corticotherapy for 6 months. At 1 month, partial clinical improvement was noticed, and MRI showed a normal size conus medullaris. At 6 months, there was complete clinical recovery. This case shows that a severe neurological deficit by Sm may have a clinical full recovery after treatment.

Spinal intradural extramedullary hydatidosis: report of three cases.

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.

Cauda equina syndrome caused by primary lumbosacral and pelvic hydatid cyst: a case report.

INTRODUCTION: Hydatid disease occurs in humans as a result of faeco-oral contamination and spinal echinococcosis is rare even in areas where echinococcosis is endemic. Hydatid cyst primarily occurs in the liver and lungs. Bone involvement constitutes only 0.5-2% of all hydatidoses. About half of the bone involvement occurs in vertebrae. The thoracic spine is the most common site of the spinal hydatidosis. Primary hydatid cysts of the lumbar and sacral spinal canal are very rare. CASE REPORT: We present a 31-year-old man with cauda equina syndrome caused by a primary hydatid cyst of the lumbosacral and pelvic areas. He had been admitted to hospital with left foot and low back pain three years ago. Magnetic resonance imaging revealed an intraspinal hydatid cyst extending from L2 to S2. The cyst had been totally removed. He was symptom-free for three years. After three years, he presented with acute cauda equina syndrome. His neurological examination revealed total plegia of dorsal flexion of the left foot and perianal hypoaesthesia. MRI showed lumbosacral and pelvic hydatidosis again. After total removal of the cyst, his neurological status revealed immediately relief. DISCUSSION: Hydatid cyst is an important health problem in some countries including Turkey. Bone involvement is seen in only 0.5-2% of cases. Furthermore sacral and lumber vertebral involvement is extremely rare. We presented a case with a spinal hydatid cyst which classified as a combination of intraspinal extradural, vertebral and paravertebral forms according to the Braitwate and Lees classification. Surgical excision and additional medical treatment is still the most effective treatment. Cysts located intraspinally have a tendency to rupture spontaneously. For this reason the high recurrence rate (30- 40%) is still a major problem in management.

Schistosoma mansoni myelopathy: clinical and pathologic findings.

Thirteen patients with Schistosoma mansoni myelopathy are reported. Neurologic syndromes included acute areflexic flaccid paraplegia (three), thoracic myelopathy with hyperreflexia and Babinski sign (six), and a cauda equina syndrome (four). Inflammatory granulomas and a schistosome worm in a leptomeningeal vein of the spinal cord were observed in the one patient coming to necropsy.

Unusual form of neurocysticercosis associated with HIV infection.

Concurrent infection with Taenia solium and HIV would be expected to occur more frequently because of the increasing frequency of HIV infection in endemic areas of cysticercosis. However, little is known about the influence of HIV infection on the frequency and the clinical course of cysticercosis. Giant cysts and racemose forms of neurocysticercosis seem to be more frequent in HIV-infected patients and may be secondary to an uncontrolled parasitic growth because of an impaired cell-mediated immune response. We report an unusual case of epidural spinal racemose neurocysticercosis revealed by compression of cauda equina in an HIV-infected man and discuss the potential interactions between T. solium and HIV infections.

Cauda-conus syndrome resulting from neurocysticercosis.

A 60-year-old male, presented with insidious onset, gradually progressive, burning paresthesia over the saddle area, sphincteric disturbance, impotence and paraparesis. Investigations revealed a ring-enhancing lesion in the conus medullaris suggestive of neurocysticercosis. This was supported by quantitative enzyme-linked immunosorbant assay from purified cell fraction of taenia solium cysticerci. On treatment with steroids he showed marked improvement.

Primary spinal extradural hydatid cyst in a child: case report and review of the literature.

Spinal hydatid cyst is a rare but serious condition. An 8-year-old boy presented with back pain, progressive weakness and numbness in both legs. Magnetic resonance imaging (MRI) of the lumbar region showed a cystic lesion with regular contour located in extradural space. There was cerebrospinal fluid- (CSF-) like signal intensity on T1- and T2-weighted images. The lesion had excessively compressed the dural sac and caudal roots, and expanded to the L3 and L4 neural foramina. The case was explored with L2, L3, L4 laminectomy and the hydatid cyst was removed totally. The clinical presentation, diagnosis and surgical treatment of this rare case of spinal hydatid disease is discussed, and all available cases of primary extradural hydatid cyst reported in the literature are presented.

Neospora caninum infection in English Springer Spaniel littermates. Diagnostic evaluation and organism isolation.

Progressive paraparesis developed in four male English Springer Spaniel pups from a litter of five during the first 10 weeks of life. Two of the pups, which had the earliest onset of neurologic signs, were euthanatized without further workup. However, a detailed investigation was completed on the remaining two littermates at 12 weeks of age. Both pups had progressive paraparesis for 3 to 4 weeks before presentation, with one dog developing subsequent asymmetric pelvic limb extensor rigidity. Based on results from neurologic examination, cerebrospinal fluid (CSF) analysis, electrophysiology, and muscle/nerve biopsy, a presumptive diagnosis of protozoal polyradiculitis and polymyositis was made. Necropsy of the most severely affected pup confirmed the clinical diagnosis of inflammatory nerve root and muscle disease but no organisms were found. To increase the potential yield of organisms, the second pup was placed on immunosuppressive doses of corticosteroids and euthanatized 2 weeks later. Numerous organisms were found in lesions in muscle and the central nervous system. Organisms grew in tissue culture and were isolated from the peritoneal fluid of gerbils inoculated with infected tissue. Organisms were not isolated from inoculated mice, guinea pigs, rabbits, and hamsters. No parasites were seen in feces or tissues of three cats fed infected dog tissues. Serologic testing demonstrated a strong positive titer to Neospora caninum in both pups, and electron microscopy showed the characteristic morphology of this parasite.

Spinal sensory radiculopathy due to Angiostrongylus cantonensis infection.

The most common cause of eosinophilic meningitis is the rat lung worm Angiostrongylus cantonensis, a parasite which is endemic in the South East Asian and Pacific regions. While the typical clinical presentation is that of meningitis associated with an eosinophilic pleocytosis, a 45 year old man presented with a radiculomyelopathy, associated with an eosinophilic pleocytosis and cerebrospinal fluid antibodies to A. cantonensis but without signs or symptoms of meningitis. A worm was demonstrated on both computed tomographic myelography and magnetic resonance imaging scan of the spinal cord.

[Meningo-radiculitis following tick bite]. / Méningo-radiculites après piqûre de tique

The authors report nine cases of acute inflammatory polyradiculoneuritis developing one to eleven weeks after a tick bite, regressive, painful and asymmetrical, with an albumino-cellular reaction in the CSF. They stress the very particular physiognomy of this type of meningo-radiculitis, its seasonal occurrence and the uncertain nature of its pathogenesis.