Diagnosing Neurocysticercosis after a traumatic fall

Background: Neurocysticercosis (NCC) is an infection of the central nervous system caused by the tapeworm, Taenia solium, acquired from the ingestion of contaminated food or water. Larvae travel to various tissues of the human body and form cysts, leading to cysticercosis. NCC is a leading cause of acquired epilepsy worldwide. Immigrants from endemic areas are disproportionately affected by the disease which contributes to healthcare disparities. Case report: This case report discusses a 28-year-old predominantly Spanish speaking male who presented as a trauma activation secondary from a fall off a ladder. He was born in Guatemala and has been working in the United States for six years. His family member noted he was experiencing seizure-like activity and syncopal episodes over the last 3 years, but he did not seek medical evaluation. The initial concern was syncope or seizure causing the fall. CT imaging revealed an indeterminate right frontal lobe hypoattenuating mass, but no traumatic findings. Follow-up MRI showed a cyst with subtle marginal enhancement concerning for NCC. He was treated with levetiracetam, dexamethasone and albendazole for 14 days. Why should an emergency physician be aware of this: This case elucidates the importance of surveillance for NCC, as its exact prevalence is underreported in the United States. NCC should be included in the differential diagnosis of neurological symptoms, especially in populations at risk. This preventable disease when undiagnosed will increase healthcare cost and disease morbidity. The incidence of NCC in the United States is likely to increase due to immigration, international travel, and globalization.