A second seizure and the truth unveiled: adolescent neurocysticercosis acquired locally in a low-endemic region

Neurocysticercosis (NCC), caused by the larval form of Taenia solium , is a common cause of seizures in endemic regions but may go unrecognized in low-endemic settings such as the United States. We report the case of a previously healthy 19-year-old Hispanic male in New York City who presented with a second generalized tonic-clonic seizure (GTCS). Brain imaging revealed scattered sub-5 mm extra-axial calcifications on CT, consistent with chronic NCC sequelae, and a 5 mm ring-enhancing lesion with central dot sign and surrounding edema in the left frontal lobe on MRI, most consistent with an active or degenerating stage of NCC: together representing mixed-stage disease. Notably, this was his second seizure; a similar event had occurred one year earlier and was not evaluated with neuroimaging, suggesting a delayed diagnosis. There was no history of travel to T. solium-endemic regions; his family had immigrated from an endemic area, raising concern for local or intrafamilial transmission. This case highlights the importance of early and thorough evaluation, including brain imaging, after a first unprovoked seizure in adolescents and young adults: especially those from immigrant backgrounds or with epidemiologic risk factors for parasitic infections. Timely recognition of NCC can prevent recurrence and long-term neurologic complications.