SHM Converge Scientific Abstract ePoster Gallery-A Fatal Case of Neurocysticercosis

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This case describes a 21-year-old previously healthy man from Guatemala who presented with confusion, agitation, disorganized behavior, and marked unintentional weight loss. He was disoriented but had no focal neurological deficits on exam. Brain imaging revealed multiple ring-enhancing lesions, raising concern for neurocysticercosis versus CNS tuberculosis. Cerebrospinal fluid analysis showed lymphocytic pleocytosis with a bloody tap.<br /><br />He was started on empiric treatment including praziquantel, steroids, and supportive care, but his condition worsened rapidly. He required transfer to a higher level of care, intubation, and neurosurgical intervention with placement of an external ventricular drain for severely elevated intracranial pressure. A biopsy sample was obtained, repeat CSF became turbid, EEG showed severe encephalopathy with electrographic seizures, and antimicrobial therapy was broadened to include RIPE treatment for possible CNS tuberculosis. Despite hyperosmolar therapy and vasopressor support, he continued to decline and died after nine days; his family chose comfort-focused care.<br /><br />The report emphasizes that neurocysticercosis is caused by the larval form of Taenia solium and is the most common parasitic infection of the CNS and a major cause of acquired epilepsy worldwide. Infection occurs through fecal-oral ingestion of tapeworm eggs from human carriers, not from undercooked pork as is often assumed. Severe disease can cause increased intracranial pressure, cognitive decline, seizures, focal deficits, and death.<br /><br />The authors stress that neurocysticercosis may be underrecognized in the United States and should be considered in patients with neuropsychiatric symptoms and characteristic imaging findings. Early diagnosis and treatment, especially timely corticosteroid use before antihelminthic therapy, may reduce inflammatory complications and improve outcomes.

Asset Subtitle

Narmada Lavu

Meta Tag

Author List Jason Shuda, Narmada Lavu

Category Clinical Vignettes

Concept Neurocysticercosis

Concept Seizure

Concept Taenia solium

Concept Ring-Enhancing Brain Lesion

Concept Fecal-Oral Transmission

Distinguished Non-Finalist

Presenter Organization Creighton University

Presenting Author Narmada Lavu

Track Adult

Keywords

neurocysticercosis

Taenia solium

ring-enhancing lesions

intracranial pressure

cerebrospinal fluid

lymphocytic pleocytosis

electrographic seizures

corticosteroids

praziquantel

CNS tuberculosis

Neurocysticercosis

Seizure

Taenia solium

Ring-Enhancing Brain Lesion

Fecal-Oral Transmission