Presentation
History of fever 3 days back, followed by persistent vomiting and severe headache
Patient Data
Selected MRI images show a well defined, predominantly cystic mass lesion in the 4th ventricle, with a focal T1 hyperintense and T2* blooming area within, obstructing the 4th ventricular outlet, resulting in hydrocephalus. No other lesion was noted within the brain parenchyma.
Intraventricular cystic lesion excised in toto.
Case Discussion
This patient presented with fever followed by severe headache and persistent vomiting. Blood reports were suggestive of thrombocytopenia and slightly low hemoglobin levels. CSF culture report was negative for any organisms, with normal CSF sugar and CSF protein levels. CT brain was suggestive of hydrocephalus. It was followed by a contrast-enhanced MRI scan of the brain. MRI features were as described above, causing raised intracranial pressure. The patient underwent a posterior fossa craniotomy for removal of mass lesion in toto, with reservoir insertion. Histopathology confirmed the diagnosis of cysticercosis. Post-surgery, the patient recovered.
On questioning, the patient had a history of ingestion of pork few times. The hyperintense focus seen on FLAIR images within the 4th ventricular lesion, most likely represents scolex.
Case contributed by Dr Stuti Vijay Nandu and Dr Bhavin Vakil.