Parenchymal neurocysticercosis complicated by hydrocephalus: A rare case report with mechanistic insights

Cerebral cysticercosis (CC), a neglected tropical disease of the central nervous system caused by Taenia solium larvae, is rarely associated with hydrocephalus in its parenchymal form. We report a 45-year-old male with a 20-year progressive course of cognitive decline, gait instability, urinary incontinence, and recurrent seizures. Epidemiological history included long-term rural residence, close contact with free-roaming domestic pigs, poor household sanitation, lack of standardized latrine use, and unsafe human feces disposal in the endemic region, together with consumption of undercooked pork two decades prior. Neuroimaging revealed multiple ring-enhancing parenchymal cysticercal lesions in the left frontal lobe, bilateral parietal lobes, right periventricular region, and right cerebellar hemisphere. The lesions were strictly parenchymal, periventricular, and adjacent to but not inside the third ventricle, with formation of a cerebral aqueductal septum, impaired cerebrospinal fluid (CSF) circulation, and supratentorial ventricular dilatation. The patient underwent ventriculoperitoneal (VP) shunting combined with staged albendazole therapy and antiepileptic treatment, achieving significant symptomatic improvement and seizure-free survival at one-year follow-up. This case underscores the unique pathogenesis of aqueductal septum formation in parenchymal neurocysticercosis, supports the efficacy of combined surgical and medical intervention in chronic presentations, and adds to the scarce literature on this rare comorbidity.