Neurocysticercosis
Patient Presentation
F.A. is a 27 year-old male that recently emigrated from Honduras. He brought himself to the hospital because for the past two days he has been experiencing a severe headache which he consistently rates an 8 out of 10 on a pain scale of 0 to 10. The headache is unrelieved with any over the counter pain medications. F.A. is also complaining of severe nausea and vomiting which started earlier today and blurry vision which started about an hour ago.
Differential List
CNS tumor, CNS lesion, intracranial abscess
Diagnosis
A CT scan was obtained and several laboratory tests were done. The results are as follows:
CT scan of the Cerebrum: There is an increase in ventricular size of the lateral and third ventricles which are consistent with obstructive hydrocephalus. There are three small calcified neurocysticercal cysts located in the left parietal lobe. Two hypodense, non-enhancing lesions indicative of viable larvae are visible throughout parietal lobe.
Labs:
Chem 7: Chloride: 109 mmol/L (elevated), Creatinine: 0.52 mg/dL (low), other values were WNL.
Complete Blood Count : White Blood Cell Count: 13.42 K/uL (elevated), other values were WNL.
Hepatic Panel: Alanine Aminotransferase: 46 U/L (slightly elevated), other values were WNL.
Other Tests: C-Reactive Protein, High Sensitivity, Comprehensive: 0.6, LDH, Serum: 242 U/L (elevated)
Diagnosis: Hydrocephalus secondary to CNS lesions which are indicative of neurocysticercosis
Neurocysticercosis is a disease of the nervous system due to the infection of the tapeworm Taenia solium, which can be found in raw or undercooked meat. The presenting symptoms depend on where the cysts are located. Common presenting symptoms are seizures, headache, or symptoms of increased intracranial pressure.
Treatment
The patient was seen by neurosurgery and emergently sent to the operating room for placement of a ventriculoperitoneal (VP) shunt to treat the hydrocephalus.
Outcome
A postoperative CT scan of the cerebrum was obtained, confirmed placement of the VP shunt and showed that the ventricles had drained and returned to a normal size. The lesions that showed up on imaging preoperatively remain. The patient tolerated the surgery well. His blurry vision, double vision, nausea, and vomiting resolved. A mild headache, which the patient rated a 3 out of 10 postoperatively, was well controlled with Fioricet® 1 to 2 tablets every 4 hours as needed for pain. The patient was kept overnight for monitoring and then discharged home with the medication of Biltricide® (2 tablets every 8 hours for 14 days) to address the tapeworm infection. A follow-up appointment in the clinic was scheduled for next week.