A middle aged man with new epilepsy and an unusual head CT.

A 52 year old man from Mexico City, Mexico was brought to the emergency room after experiencing his first ever convulsion. Family members describe a focal motor seizure involving the right arm and face, which subsequently became a two minute long generalized seizure. He is now drowsy, but recovering with a normal neurological exam. He has not had headaches, fevers, or other unusual complaints, and has no history of prior seizures.

His non-enhanced head CT is shown below.

This axial non-enhanced head CT shows several areas of abnormality.

Can you identify the abnormalities in the CT scan above? Which of the following best describes the abnormalities?

  1. Multiple hemorrhages
  2. Intracranial calcifications
  3. Multiple meningiomas
  4. Multiple lipomas

Scroll down for the answer and for an annotated head CT.

Answer: The orange areas represent multiple areas of intracranial calcification. The light blue area is an incidental calcified choroid plexus. Hemorrhages would be expected to have surrounding edema, which is not seen. Meningiomas can be calcified, but should be adjacent to the dura.

Given the history, which of the following options do you think is the most likely cause of the multiple intracranial calcifications in this middle aged man with new onset seizures? (scroll down for the answer)

  1. Taenia solium infection
  2. HIV infection
  3. Adult onset toxoplasmosis infection
  4. Bilharzia infection
  5. Abnormal parathyroid function

The answer is 1) this is neurocysticercosis, due to Taenia solium infection. It is the most common cause of new onset epilepsy in adults in the developing world. The calcified, parenchymal granulomas seen in the CT scan above are typical for chronic neurocysticercosis, although it can also involve the meninges, ventricles, eyes or muscle. The infection is oral – fecal, acquired through the feces of other humans who have eaten contaminated pork.

The cover image is the Palacio de Bellas Artes, a well known theater in Mexico City.