Neurocysticercosis is the most common cause of acquired epilepsy in the world, yet remains a rare diagnosis in the UK.
We present the case of a vegetarian 32 year old Caucasian with an extensive travel history. Our patient presented with tapeworms in 2010, and was treated with Albendazole. In 2011 she developed generalised tonic clonic seizures. Imaging and serological findings were consistent with a diagnosis of Neurocysticercosis. She was treated with Albendazole, steroids, Lamotrigine and Levetiracetam. She remained clinically stable and seizure free with yearly MRI monitoring.
In 2015 she represented with headaches and prolonged focal seizures. MRI demonstrated active cyst degeneration with oedema in multiple locations. She was treated as an inpatient with oral steroids, increased anti-epileptics and a further course of Albendazole and Praziquantel. Subsequent MRI showed marked improvement. She was discharged, symptom free, on a reducing course of steroids.
One month later, during the steroid reduction, she re-presented with headaches. Repeat MRI showed enhancement and oedema of a previously inactive lesion at the right temporo-parieto-occipital juncture suggestive of a degenerating cyst. Dexamethasone was increased and slowly weaned, this time without complication.
Here we discuss the presentation, investigation and management of the sequelae of Neurocysticercosis.