Primary Paraspinal Hydatidosis Causing Acute Paraplegia.

The zoonotic infection hydatidosis is caused by the tapeworm cestode, Echinococcus granulosus. Though considered endemic in India where association of humans with sheep and dogs form part of the livelihood, primary skeletal muscle involvement of the disease is an extremely rare event. We report a case of primary paraspinal hydatidosis with extradural extension causing acute paraplegia. Excision of the cyst and decompression of the cord was done along with albendazole therapy. Paraspinal hydatid disease is a rare entity, and in regions where hydatid disease is endemic, it can be involved in the differential diagnosis of acute compressive myelopathy. Although antihelminthic chemotherapy forms the mainstay of the treatment, surgical intervention forms a major part of the management.

Primary calvarial tuberculosis.

BACKGROUND: Tuberculosis is a very common disease in India. Its prevalence, capacity to affect every other organ, and atypical presentations make it an important part of the differential diagnosis for cases presenting in the rural setup. Primary tuberculous caries of the calvarium is a rare manifestation of this common entity. CASE DESCRIPTION: A young lady presented with headache and discharging sinus of the scalp. Imaging revealed epidural abscess with midline shift. She underwent surgery, and histopathological diagnosis of tuberculous etiology was made. The pre and intraoperative images, radiological images, and histopathological images are reported and discussed. CONCLUSION: Tuberculosis should be included in the differential diagnosis of the osteolytic lesions of skull with discharging sinus. A high degree of suspicion, especially in patients from low socioeconomic status, is warranted in managing such cases.

Atlantoaxial tuberculosis: Outcome analysis.

BACKGROUND: Tuberculous (TB) spondylitis occurs in <1% of patients with TB. Atlantoaxial involvement is extremely rare amounting to 0.3%-1% cases of TB spondylitis. The management of this entity has been fluctuating with time. Various classifications and management protocols have also evolved. We present our experience in managing this entity in 8 patients. MATERIALS AND METHODS: Retrospective follow-up study of eight patients with atlantoaxial TB over 2 years. They ranged in age from 14 to 33 years with male preponderance. Four required surgical intervention on initial presentation, 2 were successfully treated conservatively, and 2 had to undergo surgery after a trial of conservative management. All of them were started on antituberculous therapy (ATT) for 18 months. Patients were followed up for 8-29 months. RESULTS: Neck pain and restriction of neck movements were standard presenting features. All patients had pulmonary TB confirmed by sputum examination. Radiological investigations formed an integral part of the evaluation of disease, treatment plan, and prognosis. Improvement in symptoms has been documented in all eight. CONCLUSION: The involvement of the most mobile spinal segment and the potential cervicomedullary compression makes it a disease of utmost importance. Although ATT remains the mainstay of treatment, surgical intervention is needed for stabilizing the joint and decompressing the cervicomedullary junction. Strict adherence to medical advice and optimum surgical intervention tailored for each patient results in the successful management of the disease.