A RARE CASE OF NEUROCYSTICERCOSIS IN PREGNANCY
Author: Dr. R. Praveena, M.S. OG POST-GRADUATE
Guided by Prof. and HOD Dr. V. Rajalakshmi, MD, DGO,
Asst. Prof Dr. Preetha, MD, DGO, Govt. RSRM lying in hospital Govt. Stanley Medical College, Chennai
Introduction
Taenia solium or more commonly called tape worm is one of an
intestinal parasite.
Neurocysticercosis is a preventable infection caused by larval
cysts of the Tape worm. These larval cysts infect various parts of
the body causing a condition known as cysticercosis. Larval
cysts in the brain cause a form cysticercosis called
Neurocysticercosis. Neurocysticercosis which affects the brain is
the most severe form of the disease.
How do people get Neurocysticercosis?
If a person eats undercooked , infected pork , he/she will acquire
a tape worm infection in the intestine . They will then pass tape
worm eggs in their stools. If they don’t wash their hands properly
after defecation , they may contaminate food or surfaces with
feces containing these eggs. These eggs may be swallowed by
another person or the same person if they eat contaminated food.
Once inside the body, the eggs hatch and become larvae that find
their way to the brain. These larvae cause Neurocysticercosis.
Case Report
A 20yr old Primi with 38 weeks gestation , resident of Old
washermanpet came to OPD for regular antenatal visits. Her
Blood pressure was 140/90 mm Hg and repeat Blood pressure
after 4 hours was also 140/90 mm Hg . Patient was admitted in
view of Newly diagnosed Gestational hypertension.
DELIVERY
Induction of Delivery was done in view of Term and
Gestational hypertension.
Foley induction was followed by PGE2 gel induction was
followed by Oxytocin Acceleration. In view of Failure to
progress , patient was taken up for Emergency LSCS.
She delivered an Alive , term, Boy baby of weight 3.04kg with an
APGAR 7/10 and 8/10. The entire process of delivery was uneventful.
On Post-op Day 3, patient suddenly developed headache. Patient had
Bilateral frontal headache, which was dull aching type. There were no
aggravating factors. Headache reduced after PARACETAMOL IV
infusion. But patient had recurrent headache .
She was then advised CT Brain.
CT Brain showed a suspicious hypodensity in Right Temporal region
for further evaluation.
She was then planned for MRI Brain.
MRI Brain showed
T2/ FLAIR hyperintense lesion with surrounding edema in left medial
frontal gyrus and occipital lobe possibly Tuberculoma or
Neurocysticercosis. Suggested MRI contrast.
MRI contrast confirmed Neurocysticercosis with both vesicular and
colloidal stages of cyst.
MANAGEMENT
Patient was immediately seen by Neurologist.
A course of steroid and anti helminthic was prescribed.
Inj. DEXAMETHASONE 4mg IV BD for 5 days followed by a tapering
dose of oral Prednisolone.
Tab. PRESNISOLONE 80 mg OD for one week followed by 60 mg OD for
one week followed by 40 mg OD for one week and finally 20 mg OD for
one week along with TAB. ALBENDAZOLE 400mg BD for 21 days.
Confusion Of Diagnosis
The normal physiological changes in pregnancy contribute to
various adjustments which have an impact on the
presentation of several diseases.
The common symptoms of Neurocysticercosis are seizures,
headache, dizziness , visual disturbances, altered mental
status, etc.
These common symptoms of Neurocysticercosis are
confused with that of preeclampsia and eclampsia often
making us miss the diagnosis.
Therefore, eliciting the history of exposure in endemic areas
as well as the personal , social and family
history is the key for suspecting the diagnosis in patients in
neurological symptoms.
Matter Of Concern
Diagnosis and management of Neurocysticercosis during
pregnancy is challenging. But prompt intervention is crucial
for better maternal and fetal outcome.
There is no evidence of vertical transmission to fetus .
However, cysticercosis can be transmitted horizontally from
the mother to newborn and hence screening of mothers with
NCC for tape worm is important. All the family members
should also be screened.
Most pregnancies with NCC are associated with good
outcome and there is no fetal malformation or brain damage.
However sustained seizures may pose a major risk to the
fetus due to hypoxia.
Prevention
Proper hand washing before and after eating and after using
washroom.
Avoid eating raw and undercooked meat
Washing of raw fruits and vegetables properly.