The triad of Hakim-Adams – characterized by gait disorder, cognitive impairment and urinary incontinence – is typical of normal pressure hydrocephalus. Neurocysticercosis is caused by Taenia solium larvae and it is the most common parasitic infection of the nervous system, with its most common presentation being that of epilepsy. We present a case of intraventricular neurocysticercosis, which led to obstructive hydrocephalus and manifested clinically with the triad.

A 64-year-old woman, without any relevant past medical history, presented to a neurology appointment due to a subacute and progressive clinical presentation of cognitive impairment – mainly in memory and attention, urinary incontinence, and, more recently, gait instability. On physical examination, significant findings included slight upper-limb rigidity and mildly wide-based gait with speed limitations and foot dragging, as well as a positive pull test.

Given the presence of the triad of Hakim-Adams, the initial suspected diagnosis was normal pressure hydrocephalus. Laboratory tests were normal, including complete blood count, electrolytes, thyroid hormones and metabolic profile. A brain magnetic resonance imaging was requested; it showed severe supratentorial ventriculomegaly with leakage of transependymal fluid. Moreover, two cystic lesions compatible with neurocysticercosis were observed: one in the left Sylvian sulcus and another, measuring 14x19 mm, in the fourth ventricle. The latter was responsible for the development of obstructive hydrocephalus. Subsequently, planning for a ventriculoperitoneal shunt commenced and the patient was also treated with dexamethasone followed by albendazole.