[Micturition dysfunction triggered by spinal intramedullary neurocysticercosis].

INTRODUCTION: Neurocysticercosis is the most common parasitic disease of the human nervous system. This case report describes the rare intramedullary form of spinal neurocysticercosis.

CASE REPORT: A 26-year-old male patient demonstrated sinistral brachialgia, arm paralysis and progressive disturbance of micturition with a weak urine stream and persisting residual urine. The cervical MRI revealed a large intramedullary space-occupying lesion in the spinal cord, which was excised. Histologically, parasitic structures were detected and the lesion classified as neurocysticercosis. Retrospectively, more detailed evaluation of the patient's medical history disclosed a number of subtle early neurological symptoms of the disease. The infection was probably acquired during a stay in South America 20 years earlier. The MRI revealed additional multiple small intramedullary lesions and a large lesion in the area of the conus medullaris, which could not be excised. The clinical course was partially dramatic and eventually resulted--apart from small neurological deficits--in complete failure of micturition due to a hyposensible, hypercontractile and instable detrusor muscle. In order for the patient to empty his bladder, sterile single catheterization under anticholinergic medication became necessary.

CONCLUSIONS: Diagnosis of neurocysticercosis on clinical grounds is difficult, especially in regions like Europe, where the disease is very rare. In patients with non-specific neurological symptoms, and radiological indication of an intraspinal tumor, a history of stays in endemic regions even a long time ago, neurocysticercosis should be considered in the differential diagnosis as a possible cause.