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Case Reports
. 2020 Dec 13;12(12):e12066.
doi: 10.7759/cureus.12066.

Neurocysticercosis: An Easy to Miss Diagnosis in Non-Endemic Regions

Akshit Chitkara  1 , Sarah Chhabra  2 , Akshit Griwan  3 , Naman Khurana  4 , Piyush Puri  5
Affiliations
Case Reports

Neurocysticercosis: An Easy to Miss Diagnosis in Non-Endemic Regions

Akshit Chitkara et al. Cureus. .

Abstract

A 29-year-old male presented with swollen gums and stomatitis for the past two months. History revealed that he had moved to the United States from India six years ago and had a first episode of generalized tonic-clonic seizure with confusion and loss of consciousness. Meningioma of the brain was diagnosed, and a Gamma Knife excision of the meningioma was planned. The patient refused to proceed with the surgery and came back to India for a second opinion. Upon repeat MRI scan, the neurosurgeon revised the diagnosis to neurocysticercosis (NCC), and the patient was treated with albendazole, prednisolone, and phenytoin and recovered completely. Hence an unnecessary brain surgery was avoided. The complaint of stomatitis and gingival hypertrophy was due to the side effects of phenytoin. NCC remains a major public health problem in developing countries, and it should be considered as a differential diagnosis in patients from NCC endemic regions.

Keywords: neuro-imaging; neuro-surgery.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Axial post-contrast T1 MRI showing 16×14×21 mm conglomerate ring-enhancing lesion in the paramedian region of the right frontal lobe with surrounding edema.
Figure 2
Figure 2. Coronal post-contrast T1 MRI showing 16×14×21 mm conglomerate ring-enhancing lesion in the paramedian region of the right frontal lobe with surrounding edema.
Figure 3
Figure 3. Coronal T2 FLAIR MRI showing 16×14×21 mm conglomerate ring-enhancing lesion in the paramedian region of the right frontal lobe with surrounding edema.
FLAIR: fluid-attenuated inversion recovery
Figure 4
Figure 4. Neurocysticercosis in the right frontal lobe of the brain, post-contrast coronal MRI.
Figure 5
Figure 5. MR spectroscopy through the lesion shows normal Creatine (Cr), Choline (cho), and N-acetylaspartate (Naa) ratio with no abnormal increase in Myo-inositol (MI) or any lipid or lactate peak.
Figure 6
Figure 6. Neurocysticercosis in the right frontal lobe of the brain on MRI.
See this image and copyright information in PMC

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