A 15-year-old Peruvian girl with neurocysticercosis is reported from Cornell University, New York, and Institute Neurologicas, Lima, Peru. She had a 3-month history of headache, vomiting, and visual obscuration and a one month history of incoherent speech, confusion, and visual and auditory hallucinations. Examination revealed papilledema, neck stiffness, and psychomotor retardation. MRI of brain showed numerous diffuse cystic areas with a dramatic “Swiss cheese” appearance. The cysts in the cerebral cortex were bright on T2-weighted images, and were also apparent in the tongue and ventricles on T1 scans. FLAIR demonstrated a bright image of a scolex in the cysts. Stools showed ova of the pork tapeworm, Taenia solium. Western blot analysis was positive for cysticercosis. Treatment with albendazole (15 mg/kg/day) and prednisone (60 mg/day) for one month was effective. At 8 month follow-up, recovery was complete and MRI showed resolution of the cysts. [1]

COMMENT. The tapeworm is responsible for 10 percent of seizure admissions to emergency departments of large urban hospitals in New Mexico and California. Cysticercosis is the most common parasitic disease of the CNS worldwide, and the leading cause of late-onset epilepsy in many developing countries [2]. A double-blind, placebo-controlled trial of albendazole (800 mg/day) and dexamethasone (6 mg/day), for 10 days in 60 adult patients with cysts, reduced the number of seizures with generalization during the 2nd to 30th month after treatment [3]. A 41% reduction in the number of partial seizures was not significant, but a 67% reduction of seizures with generalization was significant.