Age / Sex : 77 / F

Chief complaint : tingling sensation of lower extremities for 7 months

1) What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

* Send Application Answers to Jae Hyuck Yi, MD (yijh@knu.ac.kr)
(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.)

Courtesy :  최상희, MD, 삼성서울병원

Sparganosis

Discussion

Findings: T1-weighted MR image shows an elongated iso-signal intensity intradural soft tissue mass in the L4 to S1 level. In T2-weighted MR image, the lesion shows heterogenous high signal intensity. About 3 cm sized cystic lesion is also noted within the mass in L5-S1 level.

Contrast enhanced T1-weighted MR image shows multiple nodularity along the cauda equina and dura of the lower T spine level and heterogeneous enhancement of mass in L4 to S1 level.

Differential Diagnosis:
    Arachnoiditis

    Leptomeningeal involvement by Tuberculosis, Lymphoma, Carcinoma

Diagnosis:  Sparganosis in spinal system

Discussion: Sparganosis is uncommon disease in human. It is relatively frequent in eastern Asia. It is caused by drinking water contaminated with infected copepods, ingesting raw or inadequately cooked snakes or frogs infected with the sparganum.
The involvement of CNS is relatively rare. Infection of the spinal system is extremely rare. Clinical findings are voiding difficulty, weakness of the limbs, sensory disturbances, and pain. It is diagnosed by surgically removed worms and Anti-sparganum antibody in CSF or serum, measured by ELISA. Treatments are removal Surgery and Medical treatment.
If removal of worm and inflammatory granulation is performed, the prognosis is good.

References:

1. Sparganosis Presenting as a Conus Medullaris Lesion - Case Report and Literature Review of the Spinal Sparganosis (Arch Neurol. 2004;61:1126-1128)

2. CT and MR Characteristics of Cerebral Sparganosis (AJNR Am J Neuroradiol 28:1700–05)