Dados do Trabalho

Título

Neurocysticercosis with extensive cervical myelitis: case report.

RESUMO

Case Report: A 59-year-old woman was diagnosed with epilepsy secondary to neurocysticercosis (NCC) at seven years old. Despite the use of albendazole, she developed cysticercal meningitis that was responsive to dexamethasone, but recurred upon withdrawal. The chronic corticotherapy resulted in aseptic necrosis of knees. Then, obstructive hydrocephalus occurred due to a suprachiasmatic cyst, requiring ventriculoperitoneal shunt and cyst removal. One year later, she had an ischemic stroke due to cysticercotic vasculitis, confirmed by arteriography. After 16 years, she presented with asymmetrical tetraparesis, fecal and urinary incontinence and neuropathic pain. Neuroimaging was suggestive of cervicomedullary transition cysts and active diffuse myelitis. Quarterly corticosteroid pulse therapy was started, reducing pain and stabilizing the motor symptoms. However, the condition worsened three years later, not responding to corticotherapy, when treatment was changed to oral methotrexate (MTX) 10mg per week, and then modified to the subcutaneous presentation to minimize gastric intolerance. Six years ago, BIPAP use was started due to severe sleep apnea and restrictive lung disease secondary to myelitis. Currently, epilepsy, neuropathic pain and motor symptoms are stable, but the patient is partially dependent on a wheelchair and needs 10mg of MTX every 21 days, besides carbamazepine, gabapentin and venlafaxine for pain control. Discussion: NCC is a disease that presents variable symptoms, being epilepsy the main one, followed by focal neurological deficit, intracranial hypertension and cognitive deficit. Only 2.7% of cases have spinal cord involvement and most of these cases present as radicular pain, sensory and motor deficits. Severe parenchymal or subarachnoid NCC may require long-term immunosuppression, with a steroid-sparing drug, such as methotrexate and etanercept, as prolonged use of corticosteroids can have serious side effects. Final comments: Serious manifestations may result from NCC and myelitis is a rare associated condition. Immunosuppression can stabilize the course of this condition.

Palavras Chave

Neurocysticercosis, complications, cysticercal meningitis, myelitis, immunosuppression.