We describe a rare case of intradural-extramedullary primary spinal
cysticercosis. A 42-year-old man visited our institute for
lower back pain. He denied having consumed raw meet. Magnetic resonance (MR) images revealed an intradural pure cystic mass at the L3-L4 level. A radiologic diagnosis of spinal arachnoid
cyst was established. Three years later, he complained of aggravated
back pain, and follow-up MR examination showed a markedly expanded
cyst, occupying the subarachnoid space from the T11 to the S1 level. L2 hemilaminectomy was performed, and a yellowish infected
cyst bulged out through the dural opening. The
cyst was removed en bloc. The histopathological findings of the
cyst were consistent with
parasitic infection. Serum
enzyme-linked
immunosorbent assay (ELISA) confirmed the presence of spinal
cysticercosis. As there was no intracranial lesion, the final diagnosis was primary spinal
cysticercosis, which is very rare. MR imaging is a sensitive diagnostic tool for detecting cystic lesions in the spine; however, it is difficult to distinguish
cysticercosis from non-infectious
cysts such as an arachnoid
cyst without using
gadolinium enhancement. Clinicians treating spinal
cysts with an unusual
clinical course should include
cysticercosis as a differential diagnosis. We recommend contrast-enhanced MR imaging and serum ELISA in the diagnostic work-up of such cases.