Cysticercosis of the Fourth Ventricle Causing Sudden Death: A Case Report and Review of the Literature

Abstract

A 15 years old girl of African origin was admitted with a history of headaches and a generalised tonic seizure. Her clinical examination including fundoscopy was normal. She claimed she had been assaulted. Within a few hours of her admission she was found dead in her bed during the ward round. Cardiopulmonary resuscitation was unsuccessful. At post-mortem, the major organs showed no pathological changes and neck dissection showed no abnormality. Neuropathological examination after formalin fixation revealed a cystic lesion in the fourth ventricle, ependymitis and acute hydrocephalus. Histology showed parts of the parasite Taenia solium and the diagnosis was neurocysticercosis. This case highlights the need for forensic and general pathologists as well as forensic medical examiners and paediatricians to be aware of neurocysticercosis as a possible cause of sudden death in the presence of normal clinical findings and negative autopsy, especially in patients from Asian, African or South American countries. As cysticercosis is the commonest cause of seizures in the developing world, neurocysticercosis needs to be considered as a cause of sudden and unexpected death in any patient with a history of headaches and/or seizures.

Subarachnoid basal neurocysticercosis: a focus on the most severe form of the disease

“…Intracranial hypertension is the main symptom of NCSAB and the major source of morbidity and mortality among NC patients [29][30][31]. Data on the frequency of ICH are scarce.…”

Repeated Peritoneal Catheter Blockage Caused by Neurocysticercosis Following Ventriculoperitoneal Shunt Placement for Hydrocephalus

“…[ 10 ] In addition, the most serious complication caused by intraventricular cerebral cysticercosis is sudden death due to acute hydrocephalus. [ 11 ] Hence, based on our experience, the decision to operation should be made as soon as possible if the intraventricular cyst exhibits mass effect and cerebrospinal fluid obstruction. [ 12 ] The surgical management for ventricular NCC may be used by microsurgery or endoscopy.…”

Uncommon Clinical Manifestations of Cysticercosis

“…Clinical and imagenological aspects on FVNCC has been described in the medical literature [99][100][101][102][103][104][105][106][107][108] and can be sumarized as follow: Symptoms and sings of intracraneal hypertension due to obstructive hydrocephalus [99,[100][101][102][103][104][105][106][107] , blurred vision, loss of consciousness, [100] sudden death, [108] reversible parkinsonism following ventriculoperitoneal shunt, [109] Bruns syndrome, [110] positional vomiting [111] and comatose state [112] From the point of view of imagenology, the magnetic resonance imaging (MRI) is the investigation of choice which can also show: cerebrospinal fluid (CSF) signal intensity (on all pulse sequences), intra fourth ventricular cyst with scolex, and wall enhancement. On T1-weighted and Fluid Attenuation Inversion Recovery images (FAIR), the cyst wall and scolex which are not seen in other routine sequences, and the CSF flow study can show the intraluminal nature of the cyst [113] and the even imagenological appearance of multicystic tumor.…”