Critical Management of Neurocysticercosis with Hydrocephalus and Paroxysmal Sympathetic Hyperactivity: A Case Report

Introduction: Neurocysticercosis, a parasitic infection caused by Taenia solium larvae, is a prevalent health challenge in regions with poor sanitation and among individuals migrating from endemic areas. This case report discusses the complexities of neurocysticercosis management. Main symptoms and clinical findings: A 23-year-old male with neurocysticercosis-related hydrocephalus and paroxysmal sympathetic hyperactivity (PSH), presented with altered mental status, headaches, and neurological deterioration. MRI findings revealed numerous cystic lesions and characteristic findings indicative of neurocysticercosis, with subsequent CT imaging identifying progressive hydrocephalus. Main diagnoses, therapeutic interventions, and outcomes: Neurocysticercosis with hydrocephalus and PSH was diagnosed. This necessitated the placement of a ventriculoperitoneal shunt and external ventricular drain. Despite initial improvement with antiparasitic and corticosteroid therapy, the patient’s clinical course was complicated by seizures and autonomic dysregulation. PSH was suspected due to episodes of tachycardia and diaphoresis, requiring intensified anticonvulsant therapy and sedative management with propofol. Treatment adjustments included dual antiparasitic therapy (albendazole and praziquantel) and rigorous intracranial pressure management. Conclusion: This case highlights the complexities of neurocysticercosis management, particularly when complicated by hydrocephalus and PSH, emphasising the need for early recognition and dynamic treatment modifications. As neurocysticercosis increasingly affects non-endemic regions, healthcare systems must be equipped to recognise and treat its severe manifestations, with broader public health efforts focusing on prevention in endemic areas and among migrant populations. Key Points 1. This case report explores the intensive care management of a young patient with neurocysticercosis, complicated by low-pressure hydrocephalus and paroxysmal sympathetic hyperactivity. 2. The case highlights the delicate balance of cerebrospinal fluid diversion, timing of antiparasitic therapy, and autonomic stabilisation in a critically ill patient with central nervous system infection. 3. This emphasises the need for greater clinician awareness of low-pressure hydrocephalus and paroxysmal sympathetic hyperactivity, two under-recognised but serious complications that require timely, nuanced, and multidisciplinary care to improve outcomes.