What's the Diagnosis? By Dr. Abby Renko

A 56 yo F w/ hx of DM originally from Mexico presents to the ED w/ several days of intermittent R sided headache associated with photophobia, blurry vision, nausea and myalgias. Exam is significant for R scleral injection, IOP of 23 OD, 28 OS. Her neuro exam is otherwise normal without deficit. A CT scan is obtained and shown below. What's the Diagnosis? (scroll down for answer) 



Answer: Neurocysticercosis

  • Etiology: caused by tapeworm Taenia solium- found in undercooked pork or contaminated soil
  • Symptoms:
    • Common cause of seizures worldwide!
    • Seizures, headache, blurry vision, change in mental status, obstructive hydrocephalus (remember- wet, wacky, wobbly)
      • Ocular cysticercosis should be excluded by opthalmologist in all patients w/ NCC before starting anti-parasitic treatment! 
    • Rarely palpitations (due to arrhythmias/conduction abnormalities)
  • Differential Diagnosis for ring/nodular enhancing lesions:
    • Tuberculoma
    • Brain abscess
    • Mycotic granuloma
    • Primary/metastatic brain tumor
  • Diagnosis: CT scan showing cysts, may also reveal hydrocephalus
    • In the United States, most patients present with single lesion
      • Stage 1: viable cyst- round, nonenhancing lesion
      • Stage 2: degeneration- round, enhancing lesion
      • Stage 3: calcification- solid, nodular lesion (usually nonenhancing)
  • Treatment:  Praziquantel or Albendazole
    • Add steroids for patients with encephalitis, hydrocephalus or vasculitis 



Tintinalli, JE. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York, NY: McGraw-Hill Education LLC, 2016.