Positional Headaches in a Young Brazilian Woman

Abstract

A 26-year-old Brazil-born woman was hospitalized because of severe headaches that increased in severity when she moved her head. T2-fluid attenuated inversion recovery magnetic resonance imaging showed a cystic-like lesion in the right occipital horn of the lateral ventricle (Figure 1 ). Repeat magnetic resonance imaging of a ventral decubitus position showed that the free-floating cyst shifted anteriolaterally to the base of the lateral ventricle (Figure 2 ) and partially occluded the interventricular foramen (Figure 3). Enzyme-linked immunosorbent assay identified IgG against Taenia solium cysticercosis in cerebrospinal fluid and serum samples. Figure 1. T2-fluid attenuated inversion recovery magnetic resonance imaging (transverse section) of the patient, showing a free-floating Taenia solium cyst (arrow) in the right occipital horn of the lateral ventricle (supine position). Figure 2. Repeat T2-fluid attenuated inversion recovery magnetic resonance imaging of the patient in a prone position, showing a Taenia solium cyst (arrowhead) shifting anteriolaterally to the base of the lateral ventricle. Figure 3. T1-magnetic resonance imaging (sagittal section) of the patient, showing a Taenia solium cyst (*) partially occluding the third ventricle. She underwent uneventful neuroendoscopic removal of a 1.3-cm cyst (Figure 4) that was histologically compatible with a T. solium larval stage infection. Positional headaches, a characteristic feature of spontaneous intracranial hypotension, cluster headaches, and various brain tumors such as colloid cysts, are commonly self-reported by patients with intraventricular neurocysticercosis. Infections with this parasite result in partial and temporary cerebrospinal fluid obstruction of the ventricular system.1 Neuroendoscopic removal has been performed in persons with intraventricular neurocysticercosis and shows minimal perioperative complications,2 such as in our patient. Figure 4. Larval stage of Taenia solium removed from the right lateral ventricle of the patient by neuroendoscopic surgery.