The Evolution of a Ring-Enhancing Lesion

We report a case of probable neurocysticercosis in a 30-year-old non-Hispanic Caucasian patient without international travel history who presented with breakthrough seizures and a ring-enhancing lesion with perilesional edema. He first developed seizures two years prior, and his workup then demonstrated a single ring-enhancing lesion that was initially attributed to head trauma. On his presentation for breakthrough seizures, his ring-enhancing lesion demonstrated new perilesional edema, and on repeat imaging one month later, near resolution of the cystic lesion. His serum and cerebrospinal fluid serologies for Taenia solium were negative. Of note, the patient reports a friend who developed seizures at around the same time. While this patients demographics, lack of travel history, and negative serologies are not typical of neurocysticercosis in the United States, the characteristic evolution of his cystic lesion from the vesicular to the granular stage on MRI with late-onset perilesional edema and a classical presentation of seizures is most consistent with neurocysticercosis. Considering the absence of other epidemiological risk factors and the occurrence of seizures in close contact during the same timeframe, we hypothesize that the patient was exposed to T. solium through the consumption of contaminated food in the United States.