What's the Diagnosis? By Dr. Abby Renko
A 56 yo F w/ hx of DM originally from Mexico presents to the ED w/ several days of intermittent R sided headache associated with photophobia, blurry vision, nausea and myalgias. Exam is significant for R scleral injection, IOP of 23 OD, 28 OS. Her neuro exam is otherwise normal without deficit. A CT scan is obtained and shown below. What's the Diagnosis? (scroll down for answer)
- Etiology: caused by tapeworm Taenia solium- found in undercooked pork or contaminated soil
- Common cause of seizures worldwide!
- Seizures, headache, blurry vision, change in mental status, obstructive hydrocephalus (remember- wet, wacky, wobbly)
- Ocular cysticercosis should be excluded by opthalmologist in all patients w/ NCC before starting anti-parasitic treatment!
- Rarely palpitations (due to arrhythmias/conduction abnormalities)
- Differential Diagnosis for ring/nodular enhancing lesions:
- Brain abscess
- Mycotic granuloma
- Primary/metastatic brain tumor
- Diagnosis: CT scan showing cysts, may also reveal hydrocephalus
- In the United States, most patients present with single lesion
- Stage 1: viable cyst- round, nonenhancing lesion
- Stage 2: degeneration- round, enhancing lesion
- Stage 3: calcification- solid, nodular lesion (usually nonenhancing)
- Treatment: Praziquantel or Albendazole
- Add steroids for patients with encephalitis, hydrocephalus or vasculitis
Tintinalli, JE. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York, NY: McGraw-Hill Education LLC, 2016.