Abstract
INTRODUCTION: Neurocysticercosis (NCC) is a growing health problem in the United States and worldwide due to an increasing number of immigrants. Cysticercosis is caused by ingestion of the larval form of Taenia solium. The intraventricular form, NCC is seen in 7%–45% of the cases. We present a case of a young Chinese man who presented with headache and finding of an impressive intraventricular cyst related to NCC. Our case emphasizes the importance of recognition of NCC, especially in immigrant populations. CASE REPORT: A 37 year-old male Chinese immigrant with no significant past medical history presented to our facility after sustaining a head injury from a car accident. He lost consciousness briefly during the incident and had transient headache. He was admitted to the hospital for further evaluation. On physical exam, he had no neurological deficits. Non-contrast Head Computed tomography (CT) was obtained to rule out intracranial hemorrhage and found a large cystic lesion measuring 5x6x7cm in the right lateral ventricle, with partially calcification. Gadolinium- enhanced magnetic resonance imaging (MRI) of the brain was obtained and revealed a large solitary, right lateral ventricular cystic lesion containing a partially calcified mural nodule. No surrounding edema or inflammation was observed. The findings were highly suggestive of intraventricular NCC. He was born and raised in China, moved to Mexico and then to Hawai‘i three years ago. He denied previous history of headache, weakness, seizure, or visual impairment. The MRI result prompted neurosurgical evaluation. As the patient was asymptomatic and had no hydrocephalus, no surgical intervention was pursued and close outpatient follow-up was recommended. After 6 months of follow up, the patient has remained asymptomatic. Follow-up MRI after admission showed no changes in size of the cystic lesion or evidence of surrounding inflammation. DISCUSSION: Treatment for NCC should be tailored individually. In our patient who was asymptomatic, the large intraventricular cyst was an incidental finding on neuroimaging. The decision whether or not to perform endoscopic neurosurgery is very complicated; endoscopic surgery is an invasive procedure with multiple possible complications. Removal of the large cyst may decrease the risk of mechanical obstruction but may increase the risk of secondary hydrocephalus due to inflammatory damage. We present an atypically-large intraventricular NCC managed by close observation in an asymptomatic patient. The conservative approach in a seemingly complicated patient implies and emphasizes the importance of managing NCC on an individual basis.