Presentation
Seizures and headache
Patient Data
Numerous cysts are widespread predominantly in the subarachnoid spaces of the bilateral cerebral convexities, averaging 1 cm in diameter. Most cysts contain hyperdense eccentric foci in keeping with scolexes, giving a "cyst with dot appearance". Some lesions appear as fragments of calcification surrounded by white matter edema in the left frontal centrum semiovale and temporal lobe. No hydrocephalus.
Case Discussion
Neurocysticercosis (NCC) is the commonest helminthic infection of the central nervous system and one of the most important causes of secondary epilepsy worldwide 1. It occurs when humans become intermediate hosts of the pork tapeworm (Taenia solium) by ingesting eggs from contaminated food or directly from a taenia carrier by the fecal-to-oral route 2. Symptoms and signs depend on the number, size, stage, and location of the pathological changes, as well as the inflammatory host response. Infestation may also be asymptomatic.
The left high frontal and temporal lobe lesions in this patient most likely represent the source of the symptoms and most likely are the granular nodular stage since there is no discrete cyst but flecks of calcifications surrounded by edema.
The initial approach to a patient with NCC should be appropriate symptom control - analgesics and antiepileptics as indicated in general practice 3. Most antiparasitic regimes use albendazole alone or combined with praziquantel, with concomitant steroid therapy.