Grand Rounds

Paediatric Neurocysticercosis: a Case Highlighting the Significance of Dietary and Advance Neuroimaging

Rutuja Patil, Ramchandra Babar
Department of Paediatrics, MAM’s SSAM’s Sane Guruji Hospital, Hadapsar, Pune, Maharashtra, India

Address for Correspondence: Ramchandra Babar, Department of Paediatrics, MAM’s SSAM’s Sane Guruji Hospital, Malwadi, Hadapsar, Pune 411028. Email: ramchandrababar@gmail.com

Keywords: Infectious and parasitic diseases, Neurocysticercosis, Worm and Seizures, NCC and seizures, sudden onset seizures

Clinical Problem:
A 13 year old female patient brought by relatives to pediatric outpatient department with sudden, new-onset seizure. Her family reported witness twitching movements of her arms and legs that lasted for 5-10 min. She was brought to the hospital while experiencing generalized tonic-clonic seizures, along with sudden onset of headache and vomiting. There was no history of fever or trauma. On examination, she was afebrile and actively convulsing, with a heart rate of 130 bpm, respiratory rate of 30 breaths/min, and SpO2 of 98% on room air. Her Glasgow Coma Scale (GCS) score was 9, blood sugar level (BSL) was 138 mg/dL, and pupils were equal and reactive to light. Neurological examination revealed nystagmus, hyper-responsiveness, and disorientation. Respiratory and cardiac examinations were unremarkable. She has mixed dietary pattern with routinely ingestion of pork meat in her area. While providing her medical history, she complained of worsening headache nausea accompanied by scanty, non-bilious vomiting which culminated in generalized convulsions. Convulsions get reduced after introducing antiepileptic drug-Levetracetam (20mg/kg), along with sedative clonazepam (0.25mg/kg). All routine investigations sent were within normal limits. MRI brain was done under sedation to rule out any intracranial pathology, findings raised suspicion of NCC or tuberculoma. CSF was performed to rule out tuberculoma was within normal limits. MR Spectroscopy was done to confirm the diagnosis. Findings were more in favour of NCC that confirm the diagnosis. The patient was started on albendazole as an anthelmintic, dexamethasone as a glucocorticoid, and levetracetam as antiepileptic medications.

Figure 1. Magnetic resonance imaging in NCC: Images (a) (b) (c) (d): Shows well defined congulomerated ring enhancing lesion in right parieto-occipital region with mild to moderate perifocal oedema.

What is the importance of diet history and Neuroimaging in this case?