Headache in a Man from Mexico
Series Editor: Herbert l. Fred, MD
Prepared by Dipen Parikh, MD, Resident, and Niraj Mehta, MD, Associate Professor, Department of Internal Medicine, University of Texas Health Science Center, Houston
A 28-year-old Mexican man presented with headache and photophobia of 3 days’ duration. Physical examination showed no abnormality. Cranial computed tomography (CT) scan showed a lesion in the right temporal lobe (Figure), which was thought to represent a neoplasm. Craniotomy, however, revealed the presence of Cysticercus cellulosae. Subsequent serologic studies confirmed the diagnosis of neurocysticercosis, which is caused by C cellulosae. The patient received steroids, phenytoin, and albendazole. At follow-up 2 months later, he was asymptomatic.
Points to remember: Neurocysticercosis is a parasitic disease that is common in Mexico. The disease results from ingestion of incompletely cooked pork that contains the tapeworm Taenia solium. Clinical manifestations vary with disease activity and location; seizures are the most common manifestation. Other findings include pyramidal tract signs, cerebellar signs, sensory deficits, movement disorders, dementia, or any combination of these. Although diagnosis requires tissue or serologic confirmation, radiographic evidence of punctate cranial calcifications in the proper clinical setting often suffices. Treatment is symptomatic.