Diagnosing neurocysticercosis, a parasitic infection of the brain, can be particularly challenging for physicians practicing outside of regions where the disease is commonly found. A recent case report highlights the diagnostic difficulties encountered with a 62-year-old man in New Mexico who presented with a severe headache and altered mental state. The case, published in Cureus in March 2024, underscores the importance of considering neurocysticercosis even in the absence of typical risk factors.
Understanding Neurocysticercosis
Neurocysticercosis is caused by the larval stage of the pork tapeworm, Taenia solium. Infection occurs through ingestion of tapeworm eggs, typically via contaminated food or water. While often associated with areas where pigs are raised in close proximity to humans and sanitation is poor, increasing global travel and migration patterns have led to a rise in cases in non-endemic countries.
The infection can manifest in various ways, depending on the number, size, and location of the cysts in the brain. Symptoms can range from headaches and seizures to more subtle cognitive changes. Diagnosis can be complicated because symptoms are often non-specific and can mimic other neurological conditions.
A Diagnostic Puzzle in New Mexico
The patient described in the Cureus case report initially presented without a clear history of exposure to risk factors for neurocysticercosis. He had no known immunocompromising conditions, such as HIV infection, and did not report recent travel to a known endemic area at the time of initial presentation. Despite this, his intractable headache and altered mental status prompted further investigation.
Imaging studies, specifically brain scans, revealed the presence of ring-enhancing lesions – a characteristic finding in neurocysticercosis. However, serological tests, which detect antibodies against the parasite, yielded inconclusive results. This ambiguity is not uncommon, as serological tests can have limited sensitivity and specificity, particularly in cases with few cysts or in patients with chronic infections.
a thorough clinical workup, including consideration of the patient’s travel history – which was later revealed to include a past trip to an endemic region – and consultation with an infectious disease specialist, led to a probable diagnosis of neurocysticercosis.
Challenges in Non-Endemic Regions
The case illustrates a key challenge in diagnosing neurocysticercosis in non-endemic countries: a low index of suspicion. Healthcare providers may not immediately consider the disease in patients without a clear travel history or known exposure. This can lead to delays in diagnosis and appropriate treatment.
Research published in Pathogens in September 2023, focusing on diagnosis in France, highlights the need for improved diagnostic tools. The study evaluated the use of cerebrospinal fluid serology and PCR (polymerase chain reaction) for diagnosing neurocysticercosis, aiming to improve detection rates in areas where the disease is less prevalent.
The diagnostic process often relies on a combination of neuroimaging, serological testing, and clinical evaluation. Neuroimaging, such as MRI or CT scans, can reveal the presence of cysts, but cannot always definitively confirm the diagnosis. Serological tests can support the diagnosis, but, as seen in the New Mexico case, can be equivocal. Cerebrospinal fluid analysis can sometimes be helpful, but also has limitations.
The Importance of Considering Travel History
The New Mexico case emphasizes the importance of obtaining a detailed travel history from patients presenting with neurological symptoms, even if they don’t initially recall visiting an endemic area. A retrospective review of travel experiences can sometimes uncover potential exposure.
A retrospective cohort study conducted at Sheikh Khalifa Medical City in Abu Dhabi, UAE, and published in May 2025, also noted that neurocysticercosis is increasingly seen among immigrants from endemic regions. This underscores the need for heightened awareness among healthcare providers in diverse populations.
Looking Ahead
Neurocysticercosis remains a significant public health concern, particularly for travelers and immigrants from endemic regions. Improved diagnostic tools and increased awareness among healthcare professionals are crucial for timely and accurate diagnosis, leading to appropriate treatment and improved patient outcomes. While the disease can present a diagnostic puzzle, a careful clinical evaluation, coupled with appropriate investigations, can help unravel the mystery and ensure patients receive the care they need.
