J Med Assoc Thai 2016; 99 (12):1367

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Spinal Gnathostomiasis: A Case Report with Magnetic Resonance Imaging and Electrophysiological Findings
Suksathien R Mail, Kunadison S , Wongfukiat O , Ingkasuthi K

Background: Spinal gnathostomiasis results in serious multiorgan impairments. Magnetic resonance imaging (MRI) and serology help in diagnosis, and assessing the severity and extent of the disease. However, the physiology of neural pathway could not be demonstrated. Electrodiagnosis may have a role in demonstrating the functions of the central and peripheral neural pathways and prognostic assessment of the disease.

Material and Method: An 18-year-old man presented with radicular pain and rapid progressive weakness of lower extremities, leading to paraplegia in three days. A clinical evaluation and laboratory tests, including serology, MRI, and electrodiagnosis, were performed.

Results: The investigation showed L1 paraplegia with urinary retention. The serial MRI of T-spine showed longitudinal T2 hypointense lesion along the lower thoracic spinal cord, representing track-like hemorrhage with spinal cord edema at the onset of symptoms, nodular enhancement of T11-T12 spinal cord, and enhancing and clumping of cauda equina nerve roots in the MRI at two months after the first MRI. The CSF and serum for Gnathostoma antibody were positive. Intravenous corticosteroid and oral albendazole were given. Three months after treatment, the symptoms improved in sensation but not in motor function. The electrodiagnosis was performed. There were very small amplitudes and no response in bilateral tibial and peroneal motor nerve conduction studies (NCS) respectively. The bilateral sural sensory NCS were normal. Neither tibial somato-sensory evoke potentials (SSEP) nor motor evoke potential (MEP) was recorded. No further improvement of patient’s clinical status at eight months after onset was observed.

Conclusion: Electrophysiological findings demonstrated the function of spinal cord and peripheral nerves in the patient with spinal gnathostomiasis. There were correlations between MRI and electrophysiological findings that confirmed pathophysiology of the disease. Absence of SSEP and MEP response correlated with poor neurological outcomes in radiculomyelitis caused by Gnathostoma spp. infection.

Keywords: Spinal cord diseases, Gnathostoma, Magnetic resonance imaging, Electrodiagnosis

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