Confusion and seizure as a presentation of neurocysticercosis

Case Presentation: A 78-year-old male from Haiti presented to the emergency department with complaint of headache for one day and intermittent confusion for one month according to family. On presentation, he was alert and oriented to person and place only, he was otherwise neurologically nonfocal. Evaluation included absence of fever, WBC count elevation, pyuria and chest x-ray infiltrate. In the emergency department, a single seizure occurred. CT scan of the head showed multiple cystic lesions in periventricular white matter with a central calcified nodule. In the setting of these new imaging findings and his travel history, neurocysticercosis was suspected. MRI of brain revealed multiple cystic lesions measuring 10-15 mm with intracystic nodular calcified densities consistent with neurocysticerosis. Patient was started on albendazole, decadron taper and levetiracetam. Serology confirmed neurocysticerosis. A month later, he had an outpatient MRI that showed chronic foci of neurocysticercosis with improvement in edema and no new or enlarging lesions. Discussion: Neurocysticercosis (NCC) is a condition that develops when the larvae of T. soliumreaches the brain. Patients are frequently asymptomatic but can become confused and the lesions can become a nidus of seizure activity. NCC is a preventable yet common cause of neurologic disease in many developing countries, affecting approximately 50 million people worldwide. Although previously rare in the USA, travel and immigration to the United Sates has made it more commonly diagnosed, with more than 18,000 hospitalizations in the past decade. Conclusions: Adult-onset seizures are the most common clinical manifestation of parenchymal cysticercosis, and should be suspected in immigrants with new seizures or confusion. Findings of a scolex on MRI is pathognomonic