Alsina George A, Johnson J Patrick, McBride Duncan Q, Rhoten Patrick R L, Mehringer C Mark, Stokes John K
Cedars-Sinai Institute for Spinal Disorders, Los Angeles, California 90048, USA.
Neurosurg Focus. 2002 Jun 15;12(6):e8. doi: 10.3171/foc.2002.12.6.9.
Worldwide, cysticercosis is the most common parasitic infection of the central nervous system. In endemic regions, the incidence of neurocysticercosis (NCC) approaches 4% of the general population. The disease is predominantly intracranial, the authors of most series generally report the incidence of spinal NCC as only 1.5 to 3% of all cases. Although spinal NCC is relatively rare, it represents a distinct clinical entity that can have devastating consequences for the patient. Because of the limited size of the spinal canal, the mass effect of these lesions is poorly tolerated. Most spinal NCC occurs in the subarachnoid space where mass effect can cause spinal cord compression, although obstruction of cerebrospinal fluid pathways due to scarring of the subarachnoid space can also cause symptoms. The authors treated six patients with spinal NCC. In five cases the lesions were located in the subarachnoid space, and in one the lesion was intramedullary. All patients with subarachnoid spinal NCC required excision of the symptomatic lesions; in two cases initial medical therapy had failed. The patient with intramedullary spinal NCC experienced mild symptoms and underwent steroid therapy. All patients experienced variably improved outcomes and were eventually ambulatory. Medical therapy should be carefully considered in selected patients in whom symptoms are stable and nonprogressive. Surgical intervention is required when severe or progressive deficits occur to prevent permanent injury. In some patients recovery may be limited as a result of inflammatory injury to the spinal cord or arachnoidal adhesions.
在全球范围内，囊尾蚴病是中枢神经系统最常见的寄生虫感染。在流行地区，神经囊尾蚴病（NCC）的发病率接近普通人群的4%。该病主要发生在颅内，大多数系列研究的作者通常报告脊髓NCC的发病率仅占所有病例的1.5%至3%。尽管脊髓NCC相对罕见，但它是一种独特的临床实体，可能给患者带来毁灭性后果。由于椎管空间有限，这些病变的占位效应耐受性较差。大多数脊髓NCC发生在蛛网膜下腔，占位效应可导致脊髓受压，尽管蛛网膜下腔瘢痕形成导致脑脊液通路阻塞也可引起症状。作者治疗了6例脊髓NCC患者。5例病变位于蛛网膜下腔，1例病变位于髓内。所有蛛网膜下腔脊髓NCC患者均需切除有症状的病变；2例初始药物治疗失败。髓内脊髓NCC患者症状较轻，接受了类固醇治疗。所有患者的预后均有不同程度改善，最终都能行走。对于症状稳定且无进展的特定患者，应谨慎考虑药物治疗。当出现严重或进行性神经功能缺损时，需要进行手术干预以防止永久性损伤。在一些患者中，由于脊髓的炎性损伤或蛛网膜粘连，恢复可能有限。
