Presentation
Admitted following seizure; collateral witness described two minutes of right hand shaking / grabbing prior to collapse.
Patient Data
Several bilateral well-defined low attenuation regions around a centimeter in size, mainly at the grey-white junction. One adjacent to the left caudate nucleus. Some have punctate high density within the lesions.
In the left motor cortex, there is another lesion with internal density just under white matter and some surrounding edema.
Some of these have faint peripheral enhancement, with thicker enhancement around the left frontal lesion.
Peripheral lesions in similar distribution to the CT.
There are mostly fluid signal, with eccentric hyperintense T1 internal structures. Faint peripheral enhancement with little to no edema.
The left frontal lesion looks more active with more complex internal signal, a thicker complete rim of enhancement, and perilesional edema.
Minor sulcal effacement only, no significant mass effect.
No pulmonary or abdominal organ abnormality (no evidence of tuberculosis).
Multiple rice-grain calcifications throughout the musculature (including left shoulder girdle, thoracic paraspinal muscles, anterior abdominal muscles, psoas and gluteal muscles).
Case Discussion
There are a number of radiological findings compatible with a diagnosis of neurocysticercosis.
The brain lesions are primarily in the vesicular stage, with the left precentral gyrus lesion in the vesicular colloidal stage. This also correlates with the focal onset described in the clinical history.
Small oblong muscular "rice-grain" calcifications are also a manifestation of parasitic infection.
The patient was of south east Asian origin, where neurocysticercosis is the most common cause of seizures in young adults in endemic regions.
Further history revealed a history of unmanaged epilepsy, and serology tests were positive for Taenia solium. Anti-parasitic medication, as well as anti-epileptics and short course steroids were commenced.
Unable to process the form. Check for errors and try again.