Objective:

NA

Background:

Neurocysticercosis is the most common infectious helminthic disease in immigrant patients or those traveling to endemic areas. Fourth ventricle cyst offers a unique challenge to treatment often mandating neurosurgical treatment before prioritizing medical management owing to the risk of cyst rupture and further propagation of helminths. We describe such a challenging case of a middle-aged man with travel history outside of the United States who developed acute obstructive hydrocephalus and underwent suboccipital craniotomy for cyst removal.

Design/Methods:

A 44- year-old man with history of neurocysticercosis a year ago who presented as a transfer from outside facility for long standing holocranial headache, vision change, nausea and vomiting that worsened in past few days. Urgent evaluation with neuroimaging detected acute obstructive hydrocephalus with disseminated neurocysticercosis in left frontal area and third ventricle. An urgent external ventricular drain (EVD) was placed, and steroids were started. He then upon arrival underwent immediate suboccipital craniotomy for ventricular cyst removal and then initiated on Albendazole and Praziquantel. His hospital course was further complicated by ventriculitis with three cerebrospinal fluid cultures showing growth of Staphylococcus epidermidis which was then treated with Oxacillin. Ophthalmology also evaluated the patient who ruled out ocular involvement. After a month of hospital stay, the patient was finally discharged to an acute rehabilitation facility with plan for outpatient follow-up in the infectious disease clinic.

Results:

NA

Conclusions:

Intraventricular neurocysticercosisis a risk for acute obstructive hydrocephalus and is a surgical disease. Emergent intracranial pressure monitoring and craniotomy for cyst removal are common management strategies that offer satisfactory results with good outcomes in addition to antihelminth post-surgery.