Age / Sex : 42 / M

Chief complaint : Left Lower Extremity sensory change (onset: 1YA)

Discussion

Answer:  Toxocara Canis Myelitias

Findings:

MR : T2 high signal change with focal enhancement in left posterolateral portion of conus medullaris

Differential Diagnosis:

1. Intramedullary tumor such as astrocytoma or hemangioblastoma


2. Non-tumorous myelopathy such as MS

Discussion:

• Toxocariasis


• A zoonotic disease caused by the migration of larvae through the human viscera


• Human as an accidental host through the consumption of contaminated pork, beef, chicken meat or soil (Uncooked cow or cattle liver and meat, blood of deer)


• Commonly involves liver, skin, lungs and eyes


• Rarely, CNS involvement (hematogenous infestation)

: eosinophilic meningitis, encephalitis, myelitis

: both L/E weakness and paresthesia in myelitis

• Laboratory finding


• ELISA, Sensitivity 73~90%, Specificity 93%


• Peripheral eosinophilia in 50% of patients


• CSF eosinophilia in 10~30% of patients

• Treatment


• Albendazole & steroid


• Rx à residual sensory complaints (spastic bladder, erectile problem), persistent in half of 17 patients, (2011, Jabbour at al.)

à not significantly improved in all 8 patients (2010, Lee at al.)

• MR finding:


• mainly cervical or thoracic, within five vertebral bodies


• fusiform enlargement of the involved cord,


• isointense on T1, hyperintense on T2,


• posterior or posterolateral nodular enhancement

References:

1. European Journal of Radiology 2010;75:236-240


2. Medicine 2011;90:337-343