A Classic Neurocysticercosis Case with an Unusual Complication

Abstract

Conflicts of Interests:The Authors declare that there are no competing interests. This article is licensed under a Commons Attribution Non-Commercial 4.0 LicenseABSTRACT Cysticercosis is triggered by infection with the larval form of the tapeworm Taenia solium. The usual sites for the development of cyscticerci are the central nervous system (neurocysticercosis -NCC), subcutaneous tissue, skeletal muscle, heart muscle, and the eye. Ocular cysticercosis is caused by the growth of the larvae within ocular tissues. The extraocular muscles form is the most common type of orbital cysticercosis. We report a case of a patient admitted with seizures secondary to NCC, who developed ocular symptoms after starting combined treatment with albendazole, praziquantel and dexamethasone. The investigation revealed a cystic lesion in the lateral rectus muscle. LEARNING POINTS• Neurocysticercosis (NCC) is the main cause of epilepsy in someone coming from an endemic area; therefore, it is imperative to have a high index of suspicion.• Ocular cysticercosis can present at the time of diagnosis or can be triggered by the cysticidal treatment.• Before starting cysticidal treatment, systemic corticosteroid should be used in order to reduce the inflammatory response secondary to the release of toxins following the death of the parasite. KEYWORDS Neurocysticercosis (NCC), Taenia solium, orbit, extraocular muscles, dexamethasone CASE DESCRIPTION We present a 38-year-old male from Cape Verde, resident in Portugal. His last trip to Cape Verde had been two years previously. He has a history of alcohol and tobacco dependence. Six years previously, he had been admitted to the emergency department after collapsing. A cranial computed tomography (CT) scan revealed multiple punctiform calcifications in both cerebral hemispheres and in the cerebellum, surrounded by a small cyst and with an eccentric position, suggestive of parasitic infestation -cysticercosis. On the infectious diseases ward, treatment began with albendazole and dexamethasone. Beyond cysticidal treatment for NCC, carbamazepine was started as the diagnosis of secondary epilepsy was established. In April 2016, he was admitted again to the Emergency Department after a convulsion, presenting without fever or other neurological symptoms. He had undergone a cranial CT scan (Figs.

Neurocysticercosis: a contemporary presentation of the neuroimaging main stages

“…Cysticercosis is a tissue infection caused by larval cysts of the tapeworm Taenia solium that is acquired from faecal-oral transmission (ingestion of eggs present in contaminated food or water) and is one of the major causes of epilepsy in areas where T. solium is endemic 1 2. Migration from endemic areas is one of the reasons why Portugal is the second country in Western Europe with a higher number of human cysticercosis hospitalisation cases with a mean of 45 cases per year 3 4…”

“…Diagnosis of neurocysticercosis is based on exposure history and neuroimaging and confirmed by serological testing, but neuroimaging might be enough to establish the diagnosis if there is evidence of a scolex on a cystic lesion or a combination of parasite cysts in different stages 1 2 5…”