Neurocysticercus on the Run

  

By Adrian A. Jarquin-Valdivia, Neurosciences, Neurocritical CareTriStar Centennial Medical Center, Nashville, USANeurocritical_Care_Journal_image.jpg
Robbie Franklin, 
Neurosciences, Neurocritical CareTriStar Centennial Medical Center, Nashville, USA

Neurocritical Care, February 2019, Volume 30, Issue 1, pp 232–233

A 25-year-old Mexican immigrant acutely became unconscious. The initial head computed tomography scan demonstrated hydrocephalus, with a mass lesion in posterior third ventricle. The brain magnetic resonance imaging (MRI) (Fig. 1a, T2 axial, and T1 sagittal) showed a single cystic lesion in the posterior third ventricle. A lateral ventriculostomy was placed. Two days later, in preparation for transcallosal endoscopic surgery, a pre-surgical brain MRI (Fig. 1b, axial T1, coronal T1 + C, sagittal T1) demonstrated the cystic lesion had spontaneously migrated into the fourth ventricle, changing the surgical approach. Via a suboccipital approach, the lesion was removed. Pathological specimen corresponded to a complete, immature, larval Taenia solium cysticercus measuring 2.6 cm × 1.5 cm × 1.4 cm (Fig. 1c). Albendazole was initiated after the surgery. He had an excellent clinical outcome, without requiring permanent cerebrospinal fluid derivation. When dealing with intraventricular cysticerci(us), it is prudent to repeat brain imaging just prior to surgical removal.

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