Corral I, Quereda C, Moreno A, López-Vélez R, Martínez-San-Millán J, Guerrero A, Sotelo J
Servicio de Neurología, Hospital Ramón y Cajal, Madrid, Spain.
Spine (Phila Pa 1976). 1996 Oct 1;21(19):2284-7. doi: 10.1097/00007632-199610010-00023.
A report of a patient with cervical intramedullary cysticercosis is presented.
To report the first case of intramedullary. cysticercosis cured with drug management only, which supports the hypothesis that management with anthelmintics might be successfully used in this form of cysticercosis.
Intramedullary cysticercosis is a rare manifestation of neurocysticercosis. Every treated patient reported to date has undergone surgery, frequently necessary for diagnosis. Since the anthelmintics praziquantel and albendazole were shown to be effective in parenchymal brain cysticercosis, these drugs have been considered potentially useful in patients with intramedullary cysticercosis. Nevertheless, no case yet had been reported to be cared with only medical therapy.
The treatment of a patient who suffered multiple cysticercal reinfestations of the nervous system is presented.
The patient received prolonged treatment with albendazole because of superimposed cerebral reinfestations. During this treatment, she suffered acute paraparesis, and cervical magnetic resonance imaging showed cyst-like lesions with linear gadolinium enhancement and perilesional edema, indicative of dying cysticerci and inflammatory host reaction. Dexamethasone was added, and progressive neurologic improvement followed with complete resolution of intramedullary lesions.
A preoperative diagnostic suspicion of cysticercosis is important in patients with intramedullary cystic lesions because specific drug treatment is available. Treatment with anthelmintics, particularly albendazole, should be considered in patients with intramedullary cysticercosis before surgery. Corticosteroids may be added to the therapeutic regimen because this may reduce the perilesional edema and prevent neurologic deterioration during the course of anthelmintic treatment.
本文报告了一例颈椎髓内囊尾蚴病患者。
报告首例仅通过药物治疗治愈的髓内囊尾蚴病病例，这支持了抗蠕虫药物治疗可能成功用于这种囊尾蚴病的假说。
髓内囊尾蚴病是神经囊尾蚴病的一种罕见表现形式。迄今为止报道的每例接受治疗的患者均接受了手术，而手术常常是诊断所必需的。由于抗蠕虫药物吡喹酮和阿苯达唑已被证明对脑实质囊尾蚴病有效，因此这些药物被认为可能对髓内囊尾蚴病患者有用。然而，尚无仅通过药物治疗的病例报告。
介绍了一名患有神经系统多次囊尾蚴再感染患者的治疗情况。
由于脑部再次感染，该患者接受了长时间的阿苯达唑治疗。在此治疗期间，她出现急性双下肢轻瘫，颈椎磁共振成像显示有囊肿样病变，伴有线性钆增强和病灶周围水肿，提示囊尾蚴死亡及宿主炎症反应。加用了地塞米松，随后神经功能逐渐改善，髓内病变完全消退。
对于有髓内囊性病变的患者，术前诊断怀疑囊尾蚴病很重要，因为有特异性药物治疗方法。对于髓内囊尾蚴病患者，在手术前应考虑使用抗蠕虫药物治疗，特别是阿苯达唑。治疗方案中可加用皮质类固醇，因为这可能减轻病灶周围水肿并防止抗蠕虫治疗过程中的神经功能恶化。
