Objective:

Non applicable

Background:

Neurocysticercosis is a common cause of seizures in developing countries. The racemose variety of neurocysticercosis is a rare form which infiltrates the subarachnoid space and if not treated can be sometimes fatal. Its diagnosis is challenging due to its variable clinical manifestations (even sometimes mimicking a stroke). Imaging usually plays a vital role in its diagnosis and lack of diagnostic facilities in most areas of Sub-Saharan Africa makes it difficult to detect.

Design/Methods:

The patient was a 56-year-old male initially managed for an infarctive stroke, who later presented with intermitted headaches, persistent neck pain and difficulty walking unsupported. On examination, he had normal bulk, increased tone in both lower limbs, power of 4/5 in both lower limbs, normal power in the upper limbs, brisk reflexes, mild neck stiffness and negative Kernig’s sign. He had impaired vibration sense in right lower limb, unsteady gait and no other cerebellar signs were elicited

Results:

Neuroimaging (MRI with contrast) showed grapelike clusters in the subarachnoid space diagnosing racemose neurocysticercosis with moderate communicating hydrocephalus. The patient was successfully treated with antiparasitic therapy (albendazole and praziquantel) and corticosteroids. His symptoms had significantly improved after a two-month period.

Conclusions:

This case highlights the importance of considering neurocysticercosis as a differential diagnosis in patients presenting with chronic signs of meningism, especially in endemic areas and the important role of neuroimaging in the evaluation of patients presenting with adult-onset seizures in neurocysticercosis endemic areas. Early diagnosis and appropriate medical management can lead to significant clinical improvement and help prevent severe complications.