P-OT005. A rare cause of multiple cystic brain lesions: Brain metastasis mimicking neurocysticercosis (NCC)

Abstract

Introduction . Lung malignancy is one of the leading cause of brain metastasis. Results . A case of multiple cystic metastasis brain lesions which mimicked NCC was reported. A 71 years old lady with no previous medical illness, presented with progressively worsening memory and deterioration in self-care for the past 3 weeks. She became drowsy and unable to ambulate 1 week ago. She was a non-smoker and had history of travelling to India 1 month ago. Clinically, GCS of E2M4V2, pupils symmetrically 2 mm, sluggish reactive. Neurological examination showed bilateral upper limbs and lower limbs hypertonia with brisk reflexes, plantar reflexes up-going. Lumbar puncture was performed with opening pressure of 6 cmH2O, cerebral spinal fluid (CSF) showed protein of 0.23 g/L, glucose ratio 0.6, cell count zero, absent of malignant cells and Mycobacterium tuberculosis . Serum toxoplasma IgG was negative. There was a single solitary nodule size 1 cm x 2 cm at right upper zone found in chest radiograph. She was empirically treated for NCC with oral Albendazole 400 mg bd for 2 weeks due to magnetic resonance imaging (MRI) findings of extensive cystic lesions scattered at both hemispheres, cerebellum and within brain stem. However her condition did not improve. We proceeded with computerized tomography (CT) thorax, abdomen, pelvis which showed spiculated mass size 2.0 x 2.1 x 2.2 cm at superior segment of right middle lobe with multiple hypodense lesions of varying sizes at segment VII and VIII of liver. Cysticercosis serology was negative. Family was counselled for CT guided lung biopsy but refused. Her condition remained the same and discharged home with follow-up for palliative care. Conclusion . The findings of multiple cystic brain lesions is commonly seen in NCC in an endemic country. However, in patient with no clinical improvement after treatment and negative NCC serology warrant further investigations for other rarer causes such as brain metastasis.