A 38-year-old man is brought to the emergency department with generalized tonic-clonic seizures. His wife states that he had a similar episode a month ago but did not seek medical attention. The patient emigrated from Mexico several years ago and is HIV-negative.
On examination, he is lethargic but moves all extremities on command. A CT scan of the head reveals several small cystic lesions in the cortex bilaterally as well as scattered focal areas of calcifications.
Which of the following is the most likely diagnosis?

Question

A 38-year-old man is brought to the emergency department with generalized tonic-clonic seizures.  His wife states that he had a similar episode a month ago but did not seek medical attention.  The patient emigrated from Mexico several years ago and is HIV-negative.
On examination, he is lethargic but moves all extremities on command.  A CT scan of the head reveals several small cystic lesions in the cortex bilaterally as well as scattered focal areas of calcifications.
Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

11ec193a_964c_dd51_853d_ed335a99c5db_MD0002_00 This Hispanic immigrant likely has neurocysticercosis, an important cause of seizure in individuals from endemic areas (eg, Central and South America). Neurocysticercosis occurs from ingestion of Taenia solium (pork tapeworm) eggs shed in the stool of human tapeworm carriers. Over a period of weeks, cysts can develop in the brain parenchyma (most common), intraventricular or subarachnoid space, spine, and/or eyes. After the asymptomatic viable phase (~3-5 years), cysts degenerate and can no longer evade host defenses. Inflammation causes neurologic symptoms depending on the site and extent of brain involvement (shown in table). Parenchymal brain disease typically presents with seizure and headache. Neuroimaging (eg, CT or MRI) may demonstrate multiple stages of cysts concurrently, which tend to lodge in the cerebral cortex or brainstem. Viable cysts appear as 5-20 mm round, hypodense lesions without contrast enhancement. Inflammation and edema may be apparent as the cysts degenerate, and eventually, calcified granulomas may form. Treatment generally includes antiparasitics (eg, albendazole) and/or corticosteroids. cysts (Choice B) Glioblastoma multiforme usually appears as a large solitary tumor within the cerebral hemisphere with irregular-enhancing margins and a central necrotic core. The tumor also tends to spread across white matter tracts such as the corpus callosum (eg, butterfly glioma). large solitary tumor (Choice C) Non-seminomatous germ cell tumors rarely metastasize to the brain, but when present, these typically appear as multiple lesions at the junction of gray and white matter, usually with significant surrounding edema. (Choice D) Cerebral toxoplasmosis is rare in immunocompetent hosts. However, in HIV-infected patients, it can cause encephalitis (eg, headache, confusion, fever) and appear as multiple ring-enhancing lesions on neuroimaging. ring-enhancing lesions (Choice E) Central nervous system tuberculosis usually presents with a subacute febrile illness followed by meningismus, focal deficits, confusion, and seizure. Neuroimaging may reveal basilar meningeal enhancement, hydrocephalus, and tuberculomas (iso- or hyperdense encapsulated lesions with ring enhancement). The absence of systemic symptoms or characteristic neuroimaging makes the diagnosis less likely in this patient. Educational objective: Neurocysticercosis is an important cause of seizure in individuals from endemic areas (eg, Central and South America, sub-Saharan Africa), including Hispanic immigrants. Neuroimaging (eg, CT or MRI) may reveal viable cysts (5-20 mm round, hypodense lesions without enhancement), enhancement/edema as cysts degenerate, and calcified granulomas in the cortex or brainstem. __________ References: Diagnosis and treatment of neurocysticercosis. (http://www.ncbi.nlm.nih.gov/pubmed/21912406) Neurocysticercosis: A disease of neglect. (http://www.ncbi.nlm.nih.gov/pubmed/24470993) Epilepsy and neurocysticercosis in Latin America: a systematic review and meta-analysis. (http://www.ncbi.nlm.nih.gov/pubmed/24205415)

A 38-Year-Old Man Is Brought to the Emergency Department with Generalized