Teaching NeuroImage: Cervical Myelopathy Due to Alveolar Spinal Echinococcosis Cysts.

A 64-year-old male farmer with a history of prostate adenocarcinoma, treated with curative radiotherapy 2 years prior, presented with neck pain and weakness. On examination, he had an incomplete spastic tetraparesis (3/5 strength in upper extremities, 5/5 strength in lower extremities) and sensory level below C5. Cervicothoracic MRI showed garland-like compressive epidural masses, suggestive initially of metastases (Figure 1). Stable prostate-specific antigen and negative PET-CT argued against metastases, leading to CT-guided spinal biopsy, which revealed Echinococcus multilocularis cysts. Serology was IgG-positive against alveolar echinococcosis, and chest and abdominal CT showed multiple hepatic cysts. The patient was treated with albendazole for 6 months and underwent surgical decompression, resulting in full motor recovery.