UMEM Educational Pearls

Title: A not-so-uncommon cause of seizure....

Keywords: neurocysticercosis, seizure, Taenia, tapeworm (PubMed Search)

Posted: 1/23/2013 by Andrea Tenner, MD
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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.

Attachments

1301231959_neurocysticercosis.jpg (109 Kb)