G62(P) Neurocysticercosis in a british teenager presenting as a space occupying lesion causing focal sensory-motor seizures in London. (25th October 2020)

• Record Type: Journal Article
• Authors: Tilib-Shamoun, S; Bodi, I; Godbole, G; Siddiqui, A; Zebian, B; Ramesh, V
• Is Part Of: Archives of disease in childhood. Volume 105(2020)Supplement 1
• Page Start: A20
• Page End: A20
• Publication Date: 2020-10-25
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2020-rcpch.48
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Background: Neurocysticercosis is a helminthic infestation of the brain by the encysted larval form of the human tape worm Taenia Solium. It is a common cause of focal epilepsy in countries with inadequate sanitation following oro-faecal transmission and ingestion of food contaminated with TaeniaSolium eggs. The larvae can lodge in different parts of the human body including the brain parenchyma resulting invariable neurological clinical manifestations depending on the affected site. Onset of symptoms depends on the host immune response and on parasite defence mechanism. Over 90% patients present with focal seizures. Localised oedema surrounding the lesion can result in headaches from raised intracranial pressure, obstructive hydrocephalus. Other forms include spinal cysticercosis and ophthalmic cysticercosis. The diagnosis is usually made on clinical grounds, confirmed by imaging and immunodiagnostic tests. Case Report: We report a previously well 13 year old girl who presented with a single episode of generalised tonic clonic seizure. She gave a 4 month history of altered sensation in her right upper limb and 1 month history of focal sensorimotor seizures. Examination showed subtle weakness of the right side of her face and upper arm. MRI brain scan showed a well defined left parietal lesion in the grey white matter junction with surrounding oedema and was referred to neurosurgery with suspicion of tumour. On review the images were suggestive of atypical infection - Cysticercosis or Tuberculoma. She was given Dexamethasone and Levetiracetam with good effect. At surgery she had a well encapsulated cystic lesion that was excised. Histopathology showed chronic cerebral lesion with parasitic cyst. Microscopy confirmed presence of a tapeworm larva. Following surgery she was started on Albendazole. Further history revealed regular camping trips at farms and woodland areas. She also swam in ponds and rivers. She did not report tic bites. Her diet included pork. She had been abroad. Conclusions: Unifocal Neurocysticercosis in non-endemic countries is in the list space occupying lesions mistaken for a brain tumour. It presents with focal epilepsy and its diagnosis can be challenging.