Integrating Clinical History, Imaging, and Serologic Testing for the Accurate Diagnosis of Neurocysticercosis: A Case Report

Neurocysticercosis is a parasitic infection caused by the cestode Taenia solium, in which pigs serve as the definitive hosts. Humans can become accidental intermediate hosts through the ingestion of food contaminated with Taenia solium eggs via fecal-oral transmission. Once ingested, the eggs of Taenia solium hatch into larvae, which then migrate through the bloodstream and disseminate across various organs, including the central nervous system (CNS). In this case, a 40-year-old male from Mexico with a known history of seizure disorder presented to the emergency department with altered mental status. He had been told by a physician in his native Mexico that he had an ``infection from meat,'' likely referring to cysticercosis contracted from undercooked pork. This infection was believed to be responsible for causing his seizures. Following initial presentation, he became progressively more somnolent and less responsive, necessitating transfer to a higher level of care. Initial imaging was performed with non-contrast CT of the head, revealing mild hydrocephalus and scattered calcifications throughout the cerebral cortex. Subsequent contrast enhanced MRI of the brain revealed an obstructive cystic lesion within the fourth ventricle as well as multiple enhancing and nonenhancing nodular and cystic lesions throughout the supra- and infratentorial brain, consistent with the clinical suspicion for neurocysticercosis. Subsequent serologic and radiographic confirmatory testing demonstrated disseminated disease, allowing for the confident diagnosis of neurocysticercosis. Current diagnostic criteria for neurocysticercosis allow for a range of certainty in diagnosis, from probable cases to definitive cases. This case is confirmed as definitive by the presence of both major diagnostic imaging criteria and clinical/exposure criteria.