To present a clinical case of neurocysticercosis with a single viable cyst, managed with praziquantel monotherapy.

Neurocysticercosis is a parasitic infection of the central nervous system transmitted through the fecal-oral route via Taenia solium. The preferred treatment includes albendazole in combination with dexamethasone, along with antiepileptic therapy for seizures.

A 41-year-old male, originally from Nepal with a remote history of seizures, presented to the emergency department following a witnessed generalized tonic-clonic seizure lasting approximately 15 minutes, with delayed return to baseline prior to arrival. Laboratory evaluation revealed markedly elevated creatine kinase (CK) levels exceeding 10,000 U/L. Non-contrast Computed Tomography (CT) head imaging demonstrated punctate calcifications. Magnetic resonance imaging (MRI) of the brain with contrast identified a 3 mm rim-enhancing lesion with surrounding edema in the right orbital gyrus, consistent with the colloidal vesicular stage of neurocysticercosis. The patient was started on levetiracetam for seizure prophylaxis. He was also started on albendazole and dexamethasone; however, treatment was complicated by transaminitis (peak ALT/AST 540/197) prompting a transition to oral praziquantel monotherapy. Liver enzymes and CK levels subsequently trended down, and the patient was discharged in stable condition. Repeat head imaging study is pending at this time. 

Praziquantel monotherapy may serve as an alternative treatment option for neurocysticercosis in patients who are intolerant to albendazole.