Neurocysticercosis as a first presentation of tonic-clonic seizures: a case report

We report the case of a 28 year-old immigrant Asian man from the Punjab region with a first presentation of seizures. This patient had no significant past medical history, but suffered several headaches in the preceding week and was pyrexial on presentation. A CT scan of his head showed a single area of subcortical low attenuation initially suggesting ischaemia. A lumbar puncture and CSF examination was unremarkable. Further investigation revealed discrete calcified gluteal lesions on pelvic X-ray, and serum immunology positive for cysticercosis. The diagnosis of neurocysticercosis was made, and the patient improved on dexamethasone and a short course of vermicide, to be discharged a week later. With increasing global migration, the prevalence of neurological parasitic infections seen in the UK is likely to rise. This case highlights the importance of careful interpretation of non-specific head CTs in the context of first presentation of seizures in a susceptible population.