Hospital: Hospital Universitario Virgen de las Nieves.
Aut@r o Autores: J. Parejo, M. Rabadán, J. Pozo.
A 26 year-old male was taken to the emergency department after his first epileptic seizure, which was witnessed by his partner, who tell how he suffered sudden uncontrollable jerking movements of the arms and legs and after that presented loss of consciousness and temporary confusionThe physical exam didn’t demonstrate new focal neurology deficits. He didn´t have a medical history of malignancy, AIDS or previous neurosurgery. He denied allergies or taking any prescribed medicationsNative of Bolivia, where he lived with livestock (pigs, cows), he resides in Spain for 12 years. We underwent an emergency head CT with and without IV contrast medium enhancement, that showed numerous parenchymal cysts, most of them smaller than 1 cm and mainly localized near the grey matter–white matter junction in both brain hemispheres. The larger one was located in subarachnoid space of the interhemispheric fissure. They all showed faint enhancement of the wall and most of then had a round structure within the cyst (images 1-4).
These cyst lesions were report as neurocysticercosis lesions in different evolutionary stages, predominantly in vesicular and colloidal vesicular stages. Dots inside the cyst represents the scolex. To better characterize these findings, a head MRI was taken next day, as we see in the images 3-4. The analysis of CSF serology confirmed the suspected diagnosis.Neurocysticercosis is caused by the CNS infection with the the encysted larva of the tapeworm Taenia Solium, which is endemic in most low-income countries (Central and South America, Asia and Africa.). Infection which leads to extra-intestinal disease (including neurocysticercosis) usually develops after the ingestion of eggs from the feces of a tapeworm carrier (ie, fecal-oral contamination). This form of cysticercosis is a relevant cause of seizures in these areas.On the basis of radiologic findings, neurocysticercosis is divided into four stages: 1. Vesicular: viable parasite with intact membrane (cyst with dot sign). Typically no enhancement. 2. Colloidal vesicular: the most symptomatic stage. Cyst and the wall become thickened and brightly enhances. As the membrane becomes leaky edema surrounds the cyst. Parasite dies within 4-5 years untreated 3. Granular nodular: edema decreases as the cyst retracts further. Enhancement persists but is less marked. 4. Nodular calcified: end-stage quiescent calcified cyst remnant. No edema.
Neurocysticercosis is a central nervous system infection to take into account as a cause of first episode of seizures in young adults from endemic areas.
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