Vecchio Rosa Fontana Del, Pinzone Marilia Rita, Nunnari Giuseppe, Cacopardo Bruno
Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy.
Am J Case Rep. 2014 Jan 18;15:31-4. doi: 10.12659/AJCR.889807. eCollection 2014.
Male, 23 FINAL DIAGNOSIS: Neurocysticerosis Symptoms: Diplopia • fever • headache • insomnia • neck stiffness • vomiting
Albendazole Clinical Procedure: - Specialty: Neurology.
Challenging differential diagnosis.
Neurocysticercosis is a brain infection caused by the larval stage of the tapeworm Taenia (T.) solium. It is the most important parasitic disease of the human central nervous system and represents the most common cause of acquired epilepsy in developing countries.
Here, we report the case of a 23-year-old Chinese man who presented to the emergency department with a 7-day history of helmet headache radiating to the nuchal region and associated with vomiting, confusion, and fever. Cerebrospinal fluid (CSF) was clear, with increased pressure, lymphocytic pleocytosis, decreased glucose, and increased protein levels. Bacterial antigen detection test on CSF was negative, as were CSF bacterial and fungal cultures. Despite broad-spectrum antibiotic and antiviral therapy, the patient still complained of insomnia, diplopia, headache, neck stiffness, and pain in the sacral region. A second LP was performed and CSF had the same characteristics as the first LP. A brain and spinal cord MRI revealed widespread arachnoiditis and small septated cysts with CSF-like signal in the cisterna magna, within the fourth ventricle, and at the level of L3-L4. Cysticercus-specific immunoglobin G antibodies were detected by ELISA in the CSF. The patient received albendazole (15 mg/kg/day) and dexamethasone (5 mg/day) for 4 weeks, with progressive resolution of neurological symptoms.
This case shows that, even if rare, neurocysticercosis may be responsible for meningeal symptoms and should be included in the differential diagnosis, especially in patients from endemic countries.
男性，23岁 最终诊断：神经囊尾蚴病 症状：复视、发热、头痛、失眠、颈部僵硬、呕吐
阿苯达唑 临床操作：- 专科：神经病学
具有挑战性的鉴别诊断
神经囊尾蚴病是由猪带绦虫幼虫阶段引起的脑部感染。它是人类中枢神经系统最重要的寄生虫病，也是发展中国家后天性癫痫最常见的病因。
在此，我们报告一例23岁中国男性病例，该患者因头部向颈部放射的头盔样头痛伴呕吐、意识模糊和发热7天就诊于急诊科。脑脊液（CSF）清澈，压力升高，淋巴细胞增多，葡萄糖降低，蛋白质水平升高。脑脊液细菌抗原检测试验为阴性，脑脊液细菌和真菌培养也为阴性。尽管给予了广谱抗生素和抗病毒治疗，患者仍诉失眠、复视、头痛、颈部僵硬和骶部疼痛。再次进行腰椎穿刺，脑脊液特征与首次穿刺相同。脑部和脊髓MRI显示广泛的蛛网膜炎以及在枕大池、第四脑室内和L3-L4水平有类似脑脊液信号的小分隔囊肿。通过ELISA在脑脊液中检测到囊尾蚴特异性免疫球蛋白G抗体。患者接受阿苯达唑（15mg/kg/天）和地塞米松（5mg/天）治疗4周，神经症状逐渐缓解。
该病例表明，神经囊尾蚴病即使罕见，也可能导致脑膜症状，应纳入鉴别诊断，尤其是来自流行地区的患者。
