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Question
A 38 year old man is brought in by ambulance for a seizure. His medical history is not known. On exam he is post-ictal and otherwise has a non-focal neurologic exam. He has an abrasion above the right eye, a small tongue laceration, and was incontinent of urine. A head CT was done and is shown below. What was the cause of this man's seizure?
Answer
Neurocysticercosis--a parasitic infection of the nervous system by the pork tapeworm, Taenia solium.
- Commonly found in Central and South America, Asia and Africa.
- Unlike other manifestaions of Taenia infections, neurocysticercosis is acquired by fecal-oral route (ingesting Taenia solium eggs shed in the stool of others who ingested meat infected with cysts) and therefore can be acquired by non-pork eating populations as well.
- Neurocysticercosis is the most common cause of acquired epilepsy in the developing world and a frequent cause of seizures in immigrants from endemic areas.
- 2% of seizure patients presenting to EDs in the US have neurocysticercosis.
- This patient has calcified neurocysticercosis--the only treatment is antiepileptic medication. Patients who continue to have seizures when cysts are calcified often develop chronic epilepsy.
Bottom Line:
Neurocysticercosis is a common cause of seizures globally, often with evidence of disease on CT imaging.
University of Maryland Section of Global Emergency Health
Author: Jenny Reifel Saltzberg
References
Carpio, A. Neurocysticercosis: an update. Lancet Infect Dis 2002; 2: 751–62.
Ong S, Talan DA, Moran GJ, Mower W, Newdow M, Tsang VC, Pinner RW; EMERGEncy ID NET Study Group. Neurocysticercosis in radiographically imaged seizure patients in U.S. emergency departments. Emerg Infect Dis 2002; 8: 608-13.
Garcia HH, Del Brutto OH; Cysticercosis Working Group in Peru. Neurocysticercosis: updated concepts about an old disease. Lancet Neurol 2005; 4: 653-61.