A patient presented with blurry vision and headaches for 6 months. He was found to have grade 5 papilledema with hemorrhages. MRI brain/orbits showed bilateral flattening of the posterior sclera with intraocular protrusion of the optic nerve head and prominent leptomeningeal enhancement. Extensive workup was performed which was unrevealing. A month later, the patient returned with worsening visual field and papilledema. Spinal MRI showed mildly enhanced mid-right anterolateral cord lesion and pial linings around mid-distal cord and conus. A VP shunt was placed. The antifungal treatment continued. He returned 2 months later with abdominal pain, urinary retention, and difficulty in ambulating. MRI spine showed diffuse leptomeningeal enhancement that had worsened collections, rim enhancing lesions, and cord compression and the patient underwent spinal biopsy consistent with neurocysticercosis. He improved on antiparasitic treatment, and his papilledema and visual symptoms improved. We will discuss neurocysticercosis and its presentations. We will evaluate their clinical course and management as well as the challenges.
Presentation Date: 10/14/2021
Issue Date: 11/05/2021
Discussant: Folusakin O. Ayoade, MD
Continuing Medical Education (CME)