Under Pressure: Neurocysticercosis Manifests Itself as Intracranial Hypertension (P14-10.002)

Abstract

<h3>Objective:</h3> N/A <h3>Background:</h3> Neurocysticercosis is the most common parasitic infection of the brain worldwide. Diagnosis can be challenging as cysticerca serologies take several days to result and tissue biopsy for definitive diagnosis can be invasive. Hence, having a high clinical suspicion based on epidemiological exposures, clinical presentation, and radiographic findings is crucial. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> A twenty-year-old Guatemalan female presented to the hospital with two days of fever, emesis, and confusion. She experienced positional headaches, worse on bending forward, for one month that became severe one week prior to the presentation. She was a food handler and admits to consumption of uncooked pork. Neurological exam was positive for mild disorientation and grade 5 papilledema on fundoscopic exam. Brain imaging showed two peripherally-enhancing lesions in the frontal and temporal lobes with adjacent leptomeningeal enhancement. Lumbar puncture revealed an opening pressure of 55 cm H2O. CSF studies were notable for lymphocytic and eosinophilic pleocytosis. Given her recent immigration to the United States from an endemic area and history of suspected intestinal taeniasis associated with uncooked pork consumption, neurocysticercosis was highest on the differential. Serum and CSF cysticercosis IgG were positive, thus confirming the diagnosis of neurocysticercosis. As a result, brain biopsy was not pursued. High-dose steroids were initiated prior to Albendazole with gradual improvement in symptoms. Her workplace employees and family were screened to prevent further transmission. One month later, her neurological exam was normal except for mild papilledema. <h3>Conclusions:</h3> This case highlights the importance of having a high suspicion for this potentially preventable disease in the appropriate clinical context, especially with neurocysticercosis being increasingly prevalent in non-endemic countries. It also highlights the importance of recognizing intracranial hypertension in patients with neurocysticercosis as this may alter treatment, requiring steroid initiation prior to anti-parasitic agents to prevent further brain edema from killing the larval forms of the parasite. <b>Disclosure:</b> Ms. Hillhouse has nothing to disclose. Dr. Carr has nothing to disclose. Dr. Monk has nothing to disclose. Dr. Mannyam has nothing to disclose. Dr. Britt has nothing to disclose. Dr. Jhaveri has nothing to disclose. Dr. Gunturu has nothing to disclose.