Clinical scenario
A 57-year-old male patient, waiter by occupation
without any previous comorbidities,
without any previous comorbidities,
came with complaints of the frontal
headache of one-week duration
headache of one-week duration
It was associated with, low-grade fever & chills.
The patient also complained of swaying
to the left side while walking
to the left side while walking
which affected his job in the hotel.
There were no similar complaints in the past,
no history of prior trauma,
head injury, fall or recent vaccination.
No history of seizures.
No history of loss of weight or appetite.
no history of prior trauma,
head injury, fall or recent vaccination.
No history of seizures.
No history of loss of weight or appetite.
On examination:
The patient's vitals and general physical
examination were normal.
The patient's vitals and general physical
examination were normal.
CNS examination revealed normal higher mental function.
The cranial nerves, motor system, sensory, examination were normal.
The fundus examination was also normal.
He had no signs of meningeal irritation.
However, there was the presence of bilateral cerebellar signs
in the form of ataxia,
in the form of ataxia,
dysdiadochokinesia, finger nose ataxia more on
the left side than the right.
the left side than the right.
The patient had classical cerebellar gait,
Other system examination was normal.
Evaluation
On evaluation, the patient had normal Complete blood count
Hb- 14g%, TLC-8000cells/mm3, platelets,
ESR eosinophils we’re in a normal range.
ESR eosinophils we’re in a normal range.
RBS, LFT, RFT were normal. The serology for HIV, HBsAg was negative.
MRI brain revealed multifocal ring-enhancing lesions
in supra and infratentorial neuroparenchyma with
diffuse cerebral edema suggestive of neurocysticercosis.
in supra and infratentorial neuroparenchyma with
diffuse cerebral edema suggestive of neurocysticercosis.
(Fig 1)
 |
| Fig1 Neurocystiscircosis |
CSF fluid analysis showed protein 17 mg%, glucose 91mg%,
cell count of 18 with neutrophil predominance.
CSF ADA was within normal limits.
cell count of 18 with neutrophil predominance.
CSF ADA was within normal limits.
The ZN stain of CSF was negative for AFB.
Hospital course:
His GCS at presentation was 15.
The patient was Treated with anti-edema measures
Mannitol, dexamethasone 8 mg thrice a day.
The patient was Treated with anti-edema measures
Mannitol, dexamethasone 8 mg thrice a day.
However during the course of hospital stay
patient had a drop in GCS to E4M5V4,
patient had a drop in GCS to E4M5V4,
 |
| Fig 3 Neurocystiscircosis cerebellum region |
and a ventriculoperitoneal shunt
was placed to decompress the brain.
On Post-op day 3 patient's sensorium improved and
he was discharged home a few days later
Teaching message
Bilateral cerebellar signs are more common with systemic diseases
like post-infectious cerebellitis, multiple sclerosis,
ADEM.
ADEM.
But in tropical areas, parasitic infestation should also
be considered
be considered
as a differential for acute ataxia.
Acute ataxia is an uncommon presentation of neurocysticercosis.
This case was contributed by
Dr.Shruthi S
Asst.Prof,
Dept of General Medicine Yenepoya Medical College Mangalore Karnataka
