We report a case of active neurocysticercosis presenting with new-onset seizures. Serial follow-up image findings and corresponding clinical manifestations are also reported during and after the treatment.

Neurocysticercosis is a parasitic infection of the central nervous system caused by the cystic larval stage of Taenia Solium. The severity of clinical symptoms and image abnormalities may fluctuate during the treatment.

Case report and review of literature.

A 25-year-old previously-healthy woman was admitted to the hospital for new-onset seizures. A brain MRI demonstrated a cortical-based ring enhancing cystic lesion in the temporal lobe with surrounding edema. Differential diagnoses include a brain abscess, primary brain tumor/metastases, among others. Upon further evaluation, patient reported that she grew up on a pig farm in Columbia and migrated to the US at the age of 21. A Taenia Solium serology test was positive. The patient was diagnosed with neurocysticercosis according to Infectious Diseases Society of America (IDSA) 2017 guidelines. Her physical exam, including eye exam, was normal. She was treated with levetiracetam, albendazole as well as a 10-day prednisone taper. One month later, patient was readmitted for recurrent seizures and headache. A repeat MRI showed progression of enhancement and worsening edema. The levetiracetam dose was increased and she was given another course of prednisone. Seizures and headache subsided. Repeat brain MRI study demonstrated significant improvement of enhancement and edema.

Image findings of active neurocysticercosis can mimic other conditions such as glioma and brain abscess, especially when a scolex is not visualized within the lesion. Detailed clinical, social and endemic exposure history are important for the diagnosis. Anti-helminthic treatment may cause worsening of inflammation, and steroid treatment is often required. A rapid steroid taper may cause recurrence of symptoms and worsening of image findings.