Neurocysticercosis (NCC) is a parasitic infection of the central nervous system caused by the larval stage of Taenia solium. Individuals migrating from or traveling to endemic regions may acquire the infection through ingestion of undercooked pork or consumption of water contaminated with T. solium eggs. Although relatively uncommon in the United States, clinical suspicion should be heightened in patients with relevant epidemiologic exposure who present with seizures, signs of increased intracranial pressure, recurrent headaches, or decreased visual acuity with papilledema. Diagnosis is established through neuroimaging, including computed tomography (CT) and magnetic resonance imaging (MRI), often supplemented by serologic testing. Management requires a multidisciplinary approach, incorporating ophthalmologic evaluation to rule out intraocular cysts prior to initiating antiparasitic therapy, along with adjunctive corticosteroids and antiseizure medication. We present the case of a 24-year-old incarcerated male who experienced a generalized tonic-clonic seizure. MRI revealed multiple ring-enhancing cystic lesions with surrounding vasogenic edema, leading to a diagnosis of NCC. Treatment was delayed due to unavailability of in-house ophthalmology capable of performing a fundoscopic examination. Given the patient’s status as a ward of the state, coordination with the detaining law enforcement agency was required to facilitate ophthalmologic assessment and ensure continuity of care. Additionally, medical interpretation services were utilized to provide bilingual discharge instruction emphasizing the need for follow-up ophthalmologic evaluation, antiparasitic and corticosteroid therapy, and repeat brain MRI in six months to assess lesion resolution.
Castillo et al. (Fri,) studied this question.