Journal of Community Hospital Internal Medicine Perspectives

ISSN: (Print) 2000-9666 (Online) Journal homepage: http://www.tandfonline.com/loi/zjch20

Recurrent neurocysticercosis Asad Jehangir MD, Esther Hwang MD, Anam Qureshi MBBS & Qasim Jehangir MBBS To cite this article: Asad Jehangir MD, Esther Hwang MD, Anam Qureshi MBBS & Qasim Jehangir MBBS (2014) Recurrent neurocysticercosis, Journal of Community Hospital Internal Medicine Perspectives, 4:3, 24586, DOI: 10.3402/jchimp.v4.24586 To link to this article: http://dx.doi.org/10.3402/jchimp.v4.24586

© 2014 Asad Jehangir et al.

Published online: 31 Jul 2014.

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Date: 26 April 2017, At: 01:23

JOURNAL OF COMMUNITY HOSPITAL INTERNAL MEDICINE PERSPECTIVES

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RADIOLOGY IMAGES

Recurrent neurocysticercosis Asad Jehangir, MD1*, Esther Hwang, MD2, Anam Qureshi, MBBS3 and Qasim Jehangir, MBBS4 1

PGY-1, Internal Medicine, Reading Health System, West Reading, PA, USA; 2TY, Radiology, Reading Health System, West Reading, PA, USA; 3King Edward Medical University, Lahore, Pakistan; 4 Rawalpindi Medical College, Rawalpindi, Pakistan *Correspondence to: Asad Jehangir, PGY-1, Internal Medicine, Reading Health System, Spruce Street/6th Avenue, West Reading, PA 19611, USA, Email: [email protected] Received: 8 April 2014; Revised: 21 May 2014; Accepted: 29 May 2014; Published: 31 July 2014

eurocysticercosis is fairly common, with up to 5,000 new cases in the USA every year (1). New onset neurological symptoms in patients with a history of neurocysticercosis should make the physician suspect recurrent neurocysticercosis as a potential etiology, as a considerable number of patients suffer from late neurologic sequelae (2). Radiological imaging helps in the diagnosis. CT has a better sensitivity to detect calcifications, but MRI is the most accurate imaging modality. Four recognized stages on MRI are vesicular, colloid vesicular, granular nodular, and nodular calcified. Cystic lesions demonstrating the scolex as a bright nodule, known as the ‘hole-with-dot’, is pathognomonic (3). FLAIR images have the maximum rate of scolex detection, whereas the last gadolinium-enhanced T1weighted series identifies the maximum number of lesions, which can influence the management plan (3). Treatment depends on the location and number of lesions, which usually involves antiepileptic therapy and a short course of steroids with a rapid taper.

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compatible with an active cysticercosis lesion. There were other areas of calcification within the brain without edematous change or enhancement, likely secondary to healed areas of cysticercosis. The patient was treated with a 2-week course of albendazole 400 mg BID and Decadron 4 mg BID and was advised to follow-up with neurology to taper steroids. In addition to topiramate, he was also prescribed levetiracetam to prevent further seizures. CT Head: Multiple calcifications from neurocysticercosis, largest calcification of 7 mm in left parietal lobe.

Case presentation A 52-year-old Hispanic male with a history of seizures secondary to neurocysticercosis diagnosed and treated about 10 years ago came to ED with complaints of difficulty speaking and right-sided weakness. His home medications included topiramate. On examination, he had aphasia and partial complex seizure
like activity involving the right extremities. A CT scan of the head showed scattered parenchymal calcifications, including a 7 mm calcified area in left parietal, compatible with prior history of neurocysticercosis. MRI of the brain revealed a 1 cm ring enhancing calcified lesion with surrounding edema within the left parietal lobe with the appearance

MRI Brain AX T1  C1 Flair: 1 cm ring enhancing calcified lesion within the left parietal lobe with the appearance compatible with an active cysticercosis lesion.

Journal of Community Hospital Internal Medicine Perspectives 2014. # 2014 Asad Jehangir et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Citation: Journal of Community Hospital Internal Medicine Perspectives 2014, 4: 24586 - http://dx.doi.org/10.3402/jchimp.v4.24586

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Asad Jehangir et al.

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60. doi: 10.1179/20477732 12Y.0000000028. 2. Kim SK, Wang KC, Paek SH, Hong KS, Cho BK. Outcomes of medical treatment of neurocysticercosis: A study of 65 cases in Cheju Island, Korea. Surg Neurol 1999; 52(6): 563
9. 3. Lucato LT, Guedes MS, Sato JR, Bacheschi LA, Machado LR, Leite CC. The role of conventional MR imaging sequences in the evaluation of neurocysticercosis: Impact on characterization of the scolex and lesion burden. AJNR Am J Neuroradiol 2007; 28: 1501
4. doi: 10.3174/ajnr.A0623.

2 Citation: Journal of Community Hospital Internal Medicine Perspectives 2014, 4: 24586 - http://dx.doi.org/10.3402/jchimp.v4.24586 (page number not for citation purpose)