A54-16 The Parasite Plug: A Case of Intraventricular Obstruction by a Solitary Cysticercus

Introduction Neurocysticercosis is a parasitic infection of the central nervous system caused by Taenia solium larvae, acquired through ingestion of contaminated food. It is a leading cause of acquired epilepsy worldwide, however, is relatively rare in the United States with an estimated incidence of 0.4 cases per 100,000. Case presentation A 28-year-old female with no prior medical history presented to the emergency department with acute onset of severe, projectile vomiting and worsening altered mental status. On exam she had stable vitals and was moving all extremities spontaneously, but unable to follow commands. Labs were relatively unremarkable. CT head demonstrated a hyperdensity in the third ventricle, suspicious for subarachnoid hemorrhage, with ventricular dilation consistent with obstructive hydrocephalus, as well as effacement of basilar cisterns concerning for impending transtentorial herniation. CTA head revealed findings concerning for an anterior communicating artery aneurysm. She was intubated for airway protection and a right frontal external ventricular drain (EVD) was placed. Emergent digital subtraction angiography (DSA) was performed, which did not reveal any intracranial aneurysm, malformations or significant findings. She subsequently underwent MRI brain imaging, which revealed an enhancing lesion at the foramen of Monroe, obstructing the third ventricle. Given concern for a mass lesion, she underwent a right-sided craniotomy with exploration which revealed a solitary third ventricle cysticercus later confirmed to be neurocysticercosis on pathology. Infectious disease was consulted and recommended continued care per neurosurgery. Given that this solitary cysticercus was evacuated, antiparasitic therapy nor steroids were indicated per IDSA guidelines. Once mentation improved, additional history was obtained which identified recent migration from South America, swine farming and consumption of undercooked pork as risk factors. Discussion In this patient, there was initial concern for subarachnoid hemorrhage, although the degree of hydrocephalus was out of proportion to the limited amount of blood product observed. Other differentials for intraventricular obstruction include structural malformations, neoplastic lesions, inflammatory processes and infectious lesions like the cysticercus seen intraoperatively. Isolated intraventricular neurocysticercosis is an uncommon occurrence, representing only 10-30% of cases. Complete surgical removal obviates the need for antiparasitic or corticosteroid therapy. This case not only highlights a rare cause of obstructive hydrocephalus, but also underscores the critical importance of thorough patient history to guide timely diagnosis and management. This abstract is funded by: None