Post-infectious Epilepsy from Probable Neurocysticercosis in a 32 Year Old Pregnant Female (P14-10.003)

Abstract

<h3>Objective:</h3> To report a case of neurocysticercosis management in a first trimester pregnant female. <h3>Background:</h3> Neurocysticercosis is a parasitic infection known to be endemic to some countries and is a leading cause of acquired epilepsy worldwide. Available data on the diagnosis and management of neurocysticercosis infection in pregnancy remains limited. <h3>Design/Methods:</h3> Case report <h3>Results:</h3> A 32-year-old female presented with headaches after a camping trip in the Ozarks. MRI head revealed leptomeningeal hyperintensity in the left parieto-occipital junction. Three weeks later, she presented again with seizures and was 11 weeks pregnant. The semiology was right hand somatosensory to focal clonic, then generalized. She had recently travelled to South America. Neurological exam was significant for concentration difficulty, right pronator drift, finger extension weakness, and bradykinesia with dysdidokinesia in the right hand. MRI with and without contrast demonstrated one multi-cystic lesion in the left parietal lobe without a discernable scolex, with extensive surrounding vasogenic edema. Work up demonstrated peripheral eosinophilia, and unremarkable lumbar puncture (WBC 3). Lesion biopsy demonstrated eosinophils, demyelination, and inflammation of the meninges. Given the clinical and radiographic findings, suspicion for a parasitic infection was high on the differential and a diagnosis of probable Neurocysticercosis was made. Patient was managed with levetiracetam (with high dose folate), high dose IV steroids, and a prolonged oral steroid taper for vasogenic edema. Surveillance MRIs revealed slow improvement over weeks and complete resolution to a gliotic scar without calcification by six months. <h3>Conclusions:</h3> Neurocysticercosis represents a treatment challenge in pregnancy, given the teratogenicity of antiparasitic agents and the potential for acute worsening of peri-lesional edema. Symptomatic treatment aimed at controlling seizures and the inflammatory response can help support the immunocompetent pregnant patient in the right clinical setting, while the cysts undergo natural involution. <b>Disclosure:</b> Dr. Shamim has nothing to disclose. Dr. Nwabueze has nothing to disclose. Dr. Leever has nothing to disclose. Dr. Gronseth has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Brain &amp; Life. Dr. Gronseth has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology. Dr. Gronseth has received personal compensation in the range of $0-$499 for serving as a Member/EBM consultant Guideline Development Subcommittee with AAN.