Concurrent neurocysticercosis and pulmonary tuberculosis

We discuss the case of a 24-year-old male with severe racemose neurocysticercosis.

The patient presented from an outside hospital with 4 months duration of intermittent syncope and a dull occipital headache with greatest severity in the morning. He was noted to have left facial numbness and blurred vision confined to his left eye. Magnetic resonance imaging (MRI) discovered multiple grape-like cystic structures throughout the subarachnoid space and frontal parenchyma consistent with neurocysticercosis. Additional testing revealed radiologic and culture evidence of active pulmonary tuberculosis.

The patient was admitted to the neurocritical care unit and begun on IV corticosteroids, albendazole, and 4-drug RIPE therapy. Improvement in headache, facial numbness, and nausea were noted over the course of 1 week. Visual acuity remained impaired; however, no further episodes of syncope or deterioration were noted.

Effective management of severe racemose neurocysticercosis requires appropriate diagnostic considerations, monitoring, and therapeutics well suited to a comprehensive neurocritical care unit.