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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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On Aug 2018




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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
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Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Case report
Year : 2022 | Month : May | Volume : 16 | Issue : 4 | Page : TD01 - TD03 Full Version

Isolated Intramedullary Cervical Spinal Cord Cysticercosis- A Case Report


Published: May 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55321.16296
Manu Solanki, Venkata Raviteja Reddy Gayam, Kanupriya Agrawal, Nikita Jindal, Krohit Yadav

1. Postgraduate Resident, Department of Radiodiagnosis, M.M. Institute of Medical Sciences and Research, Ambala, Haryana, India. 2. Postgraduate Resident, Department of Radiodiagnosis, M.M. Institute of Medical Sciences and Research, Ambala, Haryana, India. 3. Postgraduate Resident, Department of Radiodiagnosis, M.M. Institute of Medical Sciences and Research, Ambala, Haryana, India. 4. Postgraduate Resident, Department of Radiodiagnosis, M.M. Institute of Medical Sciences and Research, Ambala, Haryana, India. 5. PostgradUate Resident, Department of Radiodiagnosis, M.M. Institute of Medical Sciences and Research, Ambala, Haryana, India.

Correspondence Address :
Dr. Venkata Raviteja Reddy Gayam,
Room 277, I-Block, M.M. Institute of Medical Sciences and Research, MMDU Campus, Mullana, Ambala, Haryana, India.
E-mail: gayam.tejareddy@gmail.com

Abstract

Neurocysticercosis is the most prevalent parasitic infection in developing countries, caused by the encysted larvae of taenia solium. It predominantly affects the brain alone or both the brain and the spinal cord. In spinal cysticercosis, the thoracic cord is most commonly involved. Isolated involvement of the cervical spinal cord is very rare. Authors report the case of a 19-year-old male patient with intramedullary cysticercosis in the cervical cord. The lesion was diagnosed with magnetic resonance imaging and serology. Albendazole and steroids were used to treat the patient medically.

Keywords

Albendazole, Cystic lesion, Magnetic resonance imaging, Parasitic infection, Tenia solium

Case Report

A 19-year-old male patient presented to the Neurology Outpatient Department with a chief complaint of pain originating in the neck region and radiating to the left arm. On neurological examination, the muscle power was 5/5 in all the limbs and the muscle tone was 5/5. No significant anomalies were found in pain, temperature, vibration, proprioception, and tactile sensation in all four limbs. The vital signs, general examination, and systemic examination were all normal. In view of radiating pain, radiculopathy was suspected, and Magnetic Resonance Imaging (MRI) of the cervical spine was advised.

The MRI revealed a focal well-defined rounded to an elliptical intramedullary lesion in the cervical cord at the C2-C3 level with associated marked expansion of the cord. The lesion appeared hypointense on T1W images with a hyperintense rim (Table/Fig 1) and hyperintense on T2W images with a hypointense rim (Table/Fig 2)a. The lesion also had an eccentric nodule that was T1 hyperintense and T2 hypointense on imaging, indicating scolex (Table/Fig 2)a. On post-gadolinium images, thick peripheral rim enhancement with an enhancement of scolex was seen (Table/Fig 3). The lesion was associated with long segment intramedullary cord edema appearing hyperintense on T2W images, extending cranially up to the cervicomedullary junction and caudally till the lower C6 vertebral level.

Serum IgG anticysticercal antibodies were detected by Enzyme-Linked Immunosorbent Assay (ELISA) confirming the diagnosis. The patient was treated with albendazole (15 mg/kg) for 6 weeks, and dexamethasone was also given to reduce inflammation and edema of the cord. The symptoms of the patient have significantly improved 6 weeks after the treatment.

Discussion

Neurocysticercosis is the most prevalent parasitic infection caused by the encysted larvae of taenia solium. It predominantly affects the brain alone or both the brain and the spinal cord. Isolated spinal cysticercosis without intracranial involvement is rare and accounts for approximately up to 5.8% of all neurocysticercosis.(1). Cysticercosis of the spine is usually seen in young patients. It is a systemic infection that affects humans as intermediate hosts after ingestion of the pork tapeworm. Clinical features vary depending on the location, size, and stage of the infection, as well as the severity of the inflammatory response. The most common clinical features include pain, spasticity, paraparesis, and bowel and bladder dysfunction (2). Dhar A et al., in their extensive review of the literature found that majority of documented cases were located in the dorsal or dorsolumbar levels (3), while authors report a case of isolated intramedullary cysticercosis in the cervical cord region.

Spinal cysticercosis has been classified into extraspinal, which involves vertebra, and intraspinal, which includes epidural, subdural, arachnoid, and intramedullary types (4). It typically occurs in the intradural space following the dissemination of lesions from the brain through the cerebrospinal fluid. The intramedullary form of cysticercosis is rare and most commonly occurs as a result of the hematogenous transmission of a parasite. The thoracic spinal cord is prone to the disease due to the higher blood volume in this area compared to the other spinal segments. Neurocysticercosis in the cervical cord is extremely rare, and it occurs due to migration through the ventriculo-ependymal pathway (5).

Neurocysticercosis is classified into four pathological stages by Escobar. These include the vesicular stage, which consists of a small cyst containing clear fluid and a small eccentric nodule (the scolex). At this stage, the parasite is still viable, and its membrane remains intact, so there is no host reaction. In the colloid vesicular stage, the cyst fluid becomes turbid and the membrane becomes leaky with edema surrounding the cyst. This stage is the most symptomatic. The granular nodular stage is marked by the regression of cysts, which become small granulomatous nodular lesions. Surrounding edema also decreases at this stage. The final stage is a nodular calcified stage, which is an end-stage quiescent calcified cyst remnant with no edema (6).

One of the most essential diagnostic methods for detecting cysticercosis is Magnetic Resonance Imaging (MRI). The appearance of the disease on MR imaging varies depending on the stage of the disease. In the vesicular stage, an MRI scan of the spinal cord reveals a cystic lesion that appears hypointense on T1W imaging with a hyperintense scolex found eccentrically inside the cyst cavity and hyperintense on T2W images with a faint hypointense rim. A thicker capsule can be detected in the colloid stage, which is hyperintense on T1W imaging and hypointense on T2W images. Peripheral rim enhancement can be detected on post-gadalonium imaging. A calcified cyst appears hypointense both on T1WI and T2W1 (7),(8). The diagnosis of the majority of cases reported in the literature was confirmed after histopathology, however, if the MRI reveals a strong suspicion of a diagnosis, treatment may be initiated. Other differential diagnoses such as astrocytoma, ependymoma, cavernous malformations, and cystic entities (like an arachnoid cyst, and neurenteric cyst) should be ruled out. Identification of scolex on MRI can assist in diagnosis (9).

The majority of the cases of cervical spinal cord cysticercosis reported in the literature described MRI findings of the vesicular stage, however, only a few cases reported visualized scolex in them (Table/Fig 4). The present case revealed a T2W hyperintense cyst with an eccentric hypointense scolex in it consistent with the vesicular stage. Ranjan R et al., (10) and Jain N et al., (11) also reported similar findings with an eccentric hypointense scolex in the cystic lesion, which is consistent with the present case.

Medical and surgical interventions are the two mainstays of management of cysticercosis. The location of the parasite and the disease's activity are crucial guiding factors in the management of spinal cysticercosis. Surgical intervention may be needed in cases of doubtful diagnosis, acute presentation, or worsening neurological status. Surgery not only helps in decompression but also provides tissue for histological testing, which assists in the diagnosis (12). Patients with stable neurological conditions can be considered for medical treatment. Albendazole is typically given as a preoperative adjunctive treatment before surgery or as a postoperative treatment for four to six weeks at a dose of 15 mg/kg/day. In addition, dexamethasone should be administered as it may increase blood levels of albendazole and decrease treatment-induced inflammation (13). Yadav K et al., (14) reported a case in 8-year-old male who was successfully treated with albendazole and steroids. Additionally, albendazole may also be used individually as conservative treatment in suspected patients with a stable clinical course. Medical therapy alone could be advantageous in terms of avoiding surgery and treating surgically inaccessible cysticercosis (14). There are only a handful of similar cases reported in the literature which makes this a rare presentation (1),(4),(12),(14),(11),(15),(16),(17).

Conclusion

Isolated involvement of intramedullary cysticercosis in the cervical spinal cord is an unusual manifestation. The diagnosis of intramedullary cysticercosis is challenging, and neurocysticercosis needs to be strongly considered as well. The MRI is one of the most essential diagnostic methods for detecting cysticercosis. In selected cases where patients are neurologically stable, medical treatment can be considered. Early diagnosis allows the patient to be treated medically with albendazole and corticosteroids.

References

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Qi B, Ge P, Yang H, Bi C, Li Y. Spinal intramedullary cysticercosis: a case report and literature review. Int J Med Sci. 2011;8(5):420-23. Available from: http://dx.doi.org/10.7150/ijms.8.420 [crossref] [PubMed]
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Dhar A, Dua S, Singh H. Isolated intramedullary lumbar spine neurocysticercosis: A rare occurrence and review of the literature. Surg J. 2021;7(4):e327-36. Available from: http://dx.doi.org/10.1055/s-0041-1739118 [crossref] [PubMed]
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Zhao JL, Lerner A, Shu Z, Gao XJ, Zee CS. Imaging spectrum of neurocysticercosis. Radiol Infect Dis. 2015;1(2):94-102. Available from: https://www.sciencedirect.com/science/article/pii/S235262111500003. [crossref]
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Meena D, Gupta M, Jain VK, Arya RK. Isolated intramuscular cysticercosis: Clinicopathological features, diagnosis, and management - A review. J Clin Orthop Trauma. 2016;7(Suppl 2):243-9. Available from: http://dx.doi.org/10.1016/j.jcot.2016.06.016. [crossref] [PubMed]
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Kimura-Hayama ET, Higuera JA, Corona-Cedillo R, Chávez-Macías L, Perochena A, Quiroz-Rojas LY, et al. Neurocysticercosis: radiologic-pathologic correlation. Radiographics. 2010;30(6):1705-19. Available from: http://dx.doi.org/10.1148/rg.306105522 [crossref] [PubMed]
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Pant I, Chaturvedi S, Singh G, Gupta S, Kumari R. Spinal cysticercosis: A report of two cases with review of the literature. J Craniovertebr Junction Spine. 2016;7(4):285-88. Available from: http://dx.doi.org/10.4103/0974-8237.193261 [crossref] [PubMed]
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Ranjan R, Tulika, Chand S, Agnihotri A. Solitary intramedullary cervical cysticercosis without neurological deficit: A rare case report. J Pediatr Neurosci. 2017;12(1):99-101. http://dx.doi.org/10.4103/jpn.JPN_162_16 [crossref] [PubMed]
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Jain N, Gutch M, Agrawal A, Khanna A. Quadriparalytic disseminated neurocysticercosis. BMJ Case Rep. 2012;2012:bcr0820114613. Available from: http://dx.doi.org/10.1136/bcr.08.2011.4613 [crossref] [PubMed]
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Vadher A, Raval MR, Shah SD, Patel KG, Sharma K. A rare case of isolated intramedullary spinal cord cysticercosis. Cureus. 2021;13(5):e14864. Available from: http://dx.doi.org/10.7759/cureus.14864 [crossref] [PubMed]
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Chhiber SS, Singh B, Bansal P, Pandita KK, Razdan S, Singh J. Intramedullary spinal cysticercosis cured with medical therapy: case report and review of literature. Surg Neurol. 2009;72(6):765-68. Available from: http://dx.doi.org/10.1016/j.surneu.2009.06.011 [crossref] [PubMed]
14.
Yadav K, Garg D, Kaushik JS, Vaswani ND, Dubey R, Agarwal S. Intramedullary neurocysticercosis successfully treated with medical therapy. Indian J Pediatrics. 2017;84(9):725-26. Available from: https://pubmed.ncbi.nlm.nih.gov/28466406/ [crossref] [PubMed]
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Maste PS, Lokanath YK, Mahantshetti SS, Soumya S. Isolated intramedullary spinal cysticercosis: A case report with review of literature of a rare presentation. Asian J Neurosurg. 2018;13(1):154-56. Available from: http://dx.doi.org/10.4103/1793-5482.180894 [crossref] [PubMed]
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Sheehan JP, Sheehan JM, Lopes MB, Jane JA. Intramedullary cervical spine cysticercosis. Acta Neurochir (Wien). 2002;144(10):1061-63. Available from: http://dx.doi.org/10.1007/s00701-002-0985-7 [crossref] [PubMed]
17.
Barrie U, Badejo O, Aoun SG, Adeyemo E, Moler N, Christian ZK, et al. Systematic review and meta-analysis of management strategies and outcomes in adult spinal neurocysticercosis. World Neurosurg. 2020;138:504-511e8. Available from: http://dx.doi.org/10.1016/j.wneu.2020.03.093. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/55321.16296

Date of Submission: Jan 29, 2022
Date of Peer Review: Feb 25, 2022
Date of Acceptance: Apr 19, 2022
Date of Publishing: May 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 03, 2022
• Manual Googling: Feb 16, 2022
• iThenticate Software: Apr 18, 2022 (11%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com