Abstract 310: Internal Carotid Arteriopathy a rare cause of focal Neurocysticercosis ‐ A case report

Neurocysticercosis is a parasitic infection affecting the CNS, caused by Taenia Solium: commonly presenting with seizures, meningitis, encephalitis, and increased ICP. Cerebral cysticerci arteritis (CCA), a rare complication, affects small to medium‐sized arteries, commonly the middle cerebral artery (MCA), sparing the internal carotid artery (ICA). A 22‐year‐old female, an immigrant from Haiti, presented with headaches and dysarthria. Initial NIH was low, CTH demonstrated a wedge‐shaped hypodensity and CTA showed Left ICA dissection. A contrasted MR brain showed T2 FLAIR hyperintensity with ring enhancement and a “cyst‐with‐dot” appearance, suspicious for a helminthic infection. DSA showed a filling defect from the origin to the terminus of LICA, with distal reconstitution from the anterior communicating artery (ACA). A brain biopsy confirmed necrotizing inflammation with purulent exudate consistent with neurocysticercosis. She was started on steroids and anti‐helminthic treatment and was discharged with outpatient follow‐up. CCA commonly affects small to medium‐sized arteries, mostly sparing the ICA. Focal neurocysticercosis with diffuse CSF involvement can cause inflammatory arteriopathy and involve the arteries of the circle of Willis mostly the MCA, posterior cerebral artery, and ACA sparing the ICA which is unique to our patient. Management and follow‐up remain the key to secondary stroke prevention.