Researchers found that tapeworms were living in the brains of patients suffering from mysterious seizures and altered mental state.
Harvard Medical School and Massachusetts General Hospital experts published a case report last week in The New England Journal of Medicine. They said that the 38 year-old man had been “speaking gibberish” since his first seizure.
The man, who was originally from rural Guatemala, was aggressive and disoriented until arriving at the hospital. He had a witnessed generalized-tonic-clonic seizure.
Although the patient’s eyes were open – with an involuntary upward gaze – he did not verbally respond to questions or follow commands.
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Normal gag and cough reflexes. There was no history of illness, medication, or drug use. He rarely drank alcohol.
He was given two doses intravenously of lorazepam seven minutes apart. A tube for airway protection was placed in his trachea.
The chest radiograph was normal and the patient was diagnosed. The team also noted in the study that among patients who present with an apparent first seizure or other symptoms, it is important to obtain the clinical history.
Laboratory testing proved that hyponatremia, liver dysfunction, and renal dysfunction were all ruled out. The man’s urine, serum toxicology panels, and urine test results were negative. Further evaluation revealed that the man had leukocytosis as well as lactic acidosis.
An MRI is more sensitive and specific than a CT scan of a head for the detection brain parenchymal lesion detection, but it’s still more common to use a CT in an emergency department.
Dr. Andrew Cole wrote that “It is probable that this patient had CT after arrival and stabilization at the emergency department. However, if the CT study was negative MRI would eventually help us to assess for a causative anatomy abnormality.”
Cole also noted that electroencephalography (EEG), which is “extremely useful in classifying the seizure problem,” is also rarely performed rapidly in the emergency department.
Cole noted that cysticercosis is the most prevalent cause of acquired epilepsy worldwide and results from the ingesting tapeworm eggs.
“On the basis of the features of the patient’s presentation, the fact that he had been healthy the day before the seizure, and his history of living in a rural area of Guatemala, neurocysticercosis is the most likely diagnosis in this case. Cole stated that CT was performed to confirm this diagnosis. MRI and EEG were next.
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Dr. George Eng stated that if imaging results are indicative of cysticercosis then serologic studies can confirm the diagnosis.
In testing for anti-cysticercal antibodies with the use of an enzyme-linked immunoelectrotransfer blot (EITB) assay, the presence of those antibodies was negative.
“The patient had three brain lesions. One of them showed ring enhancements on MRI while the other three showed partial calcification on CT. This patient may have been immune-positive due to the calcifying progression of the lesion. Eng stated that tests for antibodies against toxoplasma and strongyloides were negative as well as an interferon-gamma assay and purified protein derivative tuberculin (TPD) skin test for tuberculosis.
The 38-year-old had tested negative for latent tuberculosis – consensus guidelines recommend that patients who will receive prolonged glucocorticoid therapy first be evaluated for latent tuberculosis – and was empirically treated with ivermectin for possible concomitant strongyloidiasis.
The man was admitted to the neurosciences ICU, and his white-cell count and lactic acid levels were both restored within hours. To control seizures, levetiracetam was administered. After 12 hours, the patient was extubated after an EEG.
The next morning, he was transferred into the neurology service and began treatment with two-weeks of albendazole/praziquantel, four-weeks of high-dose Prednisone, and a four week tapering course. On the fifth day of his stay, he was freed from hospital with no seizure activity and normal neurologic results.
The U.S. Centers for Disease Control and Prevention (CDC), notes that eating raw or undercooked beef can lead to tapeworm infection.
The Mayo Clinic warns people that living in endemic regions can increase their risk.
Source: Fox News
