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Jangam J. Diagnostic Dilemma Regarding Postpartum Seizure in the Setting of Preeclampsia. Cureus 2024; 16:e57832. [PMID: 38590978 PMCID: PMC11000682 DOI: 10.7759/cureus.57832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 04/10/2024] Open
Abstract
This case demonstrates a diagnostic dilemma regarding the management of seizures in the postnatal setting. It seeks to highlight the importance of a thorough exploration of history and risk factors for females presenting with seizures in the postpartum period to ensure appropriate treatment and workup. Preeclampsia (PET) is a hypertensive disorder of pregnancy affecting 2%-8% of pregnancies worldwide. Less than 1% of females with preeclampsia experience eclamptic seizures. However, they are associated with significant mortality and morbidity. The majority of these seizures occur in the third trimester with 80% occurring intrapartum or within 48 hours of delivery. Warning symptoms such as headache, visual disturbances, or epigastric pain are not always present. Eclamptic seizures after the first week postpartum are very rare. Seizures, in general, are triggered by many other organic and nonorganic causes, one of which is neurocysticercosis (NCC) most often caused by Taenia solium. Neurocysticercosis is endemic in sub-Saharan Africa and Southeast Asia. In endemic areas, it accounts for approximately 30% of the cases of adult-onset epilepsy, second only to tuberculosis (TB). This is a case of a 40-year-old para 1 female who experienced a postpartum seizure in the setting of preeclampsia diagnosed in the intrapartum period. She successfully underwent standard treatment for the management of eclampsia. Further workup demonstrated brain lesions suspicious for neurocysticercosis, ultimately prompting diagnosis and appropriate neurological management. Neurocysticercosis is a commonly overlooked etiology in the Australian peripartum healthcare setting. It must be included in the differential diagnosis of patients with new-onset seizures who may be from endemic areas. The diagnosis of neurocysticercosis is based on a combination of clinical findings, exposure history, imaging, and serology.
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Affiliation(s)
- Jeevan Jangam
- Department of Obstetrics and Gynecology, Ipswich Hospital, Brisbane, AUS
- School of Medicine, Griffith University, Gold Coast, AUS
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Padda I, Aziz D, Mahtani A, Sethi Y, Sebastian SA, Sexton J, Karroum P, Fabian D, Fulton M. Recurrent syncopal episodes in a pregnant patient with neurocysticercosis. Radiol Case Rep 2023; 18:3084-3088. [PMID: 37434623 PMCID: PMC10331010 DOI: 10.1016/j.radcr.2023.05.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/15/2023] [Accepted: 05/28/2023] [Indexed: 07/13/2023] Open
Abstract
Neurocysticercosis (NCC) is the most common parasitic infection of the nervous system and acquired epilepsy in low-resource settings due to the pork tapeworm, Taenia solium. Humans contract the intestinal infection of the adult tapeworm (taeniasis) through the fecal-oral route after consuming undercooked food, particularly pork or water, contaminated with tapeworm eggs. When the larvae invades the central nervous system (CNS), the infection causes NCC, which often manifests as late-onset seizures, chronic headaches, and intracranial hypertension. We describe a 31-year-old Hispanic multigravida woman from Guatemala, at 33 weeks of gestation, who presented with multiple syncopal and hypotensive episodes prompting a Computed tomography (CT) image of the head revealing multiple small cerebral calcifications indicating NCC. In this article, we highlight the significance of early symptom recognition and diagnostic workup for NCC in areas with diverse immigrant populations. We also discuss the epidemiology, clinical manifestations, and current treatment modalities available for NCC.
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Affiliation(s)
- Inderbir Padda
- Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, 355 Bard Ave, Staten Island, NY 10310, USA
| | - Daniel Aziz
- Department of Internal Medicine, Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Arun Mahtani
- Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, 355 Bard Ave, Staten Island, NY 10310, USA
| | - Yashendra Sethi
- Department of Internal Medicine, Government Doon Medical College, Dehradun, India
| | | | - Jaime Sexton
- Department of Medicine, St. George's University, University Centre Grenada, West Indies, Grenada
| | - Paul Karroum
- Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, 355 Bard Ave, Staten Island, NY 10310, USA
| | - Daniel Fabian
- Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, 355 Bard Ave, Staten Island, NY 10310, USA
| | - Matthew Fulton
- Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, 355 Bard Ave, Staten Island, NY 10310, USA
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Timsit C, Ayoub N, Arama E, Mercier F. Seizures due to neurocysticercosis in a postpartum French Congolese woman: sometimes it is the zebra. Int J Obstet Anesth 2022; 52:103601. [DOI: 10.1016/j.ijoa.2022.103601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/01/2022] [Indexed: 10/31/2022]
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Neurocysticercosis Complicating Pregnancy. Obstet Gynecol 2022; 140:220-225. [DOI: 10.1097/aog.0000000000004854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/13/2022] [Indexed: 11/26/2022]
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Batra S, Kumar S, Shekhawat LS. Neurocysticercosis presenting as bipolar disorder: a case report. Gen Psychiatr 2021; 34:e100663. [PMID: 35028524 PMCID: PMC8710892 DOI: 10.1136/gpsych-2021-100663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/16/2021] [Indexed: 11/04/2022] Open
Abstract
Neurocysticercosis is the most common neuro-parasitosis caused by the larval stage of Taenia solium. The most common manifestations include seizures and hydrocephalus. Psychiatric abnormalities are relatively rare but depressive symptoms are frequent in patients with neurocysticercosis. However, mania as a presentation is relatively rare. Pregnancy and the postpartum period are relatively vulnerable times and they can lead to reactivation of existing neurocysterci lesions. We are discussing the case of a 23-year-old female patient with neurocysticercosis leading to the reactivation of lesions in the peripartum and postpartum period leading to bipolar affective disorder. Improvement in the patient was seen with a combination of antipsychotics, antihelmintics, antiepileptics and steroids, along with improved radiological signs of neurocysterci lesions. Although neurocysticercosis is a common illness, its prevalence presenting as a manic episode is merely 2.6% and, hence, missed easily. Therefore, it is important to rule out organic aetiology in patients even with a classic presentation of bipolar affective disorder and those having any other neurological symptoms and signs.
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Affiliation(s)
- Surbhi Batra
- Department of Psychiatry, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, Delhi, India
| | - Sumit Kumar
- Department of Radiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, Delhi, India
| | - Lokesh Singh Shekhawat
- Department of Psychiatry, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, Delhi, India
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Ramesh D, Maurya DK, Gopalakrishnan MS, Pegu B, Ananthakrishnan R, Nair PP, Keepanasseril A. Diagnostic and management challenges of intraventricular neurocysticercosis presenting in the third trimester of pregnancy: A case report. Obstet Med 2021; 14:57-61. [PMID: 33995577 DOI: 10.1177/1753495x20904895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/12/2020] [Indexed: 11/16/2022] Open
Abstract
The diagnosis of neurocysticercosis in pregnancy is challenging, even in endemic areas, as other neurological conditions with similar manifestations are common. Obstetricians and physicians may be reluctant to do neuroimaging in pregnancy and often the availability is limited in endemic areas. Management of neurocysticercosis depends on the symptomatology. In those presenting with features of increased intracranial pressure early treatment is necessary, taking into consideration the gestational age and the maternal condition at presentation. Presence of intraventricular cysts causing obstructive hydrocephalus necessitates their removal due to the risk of intracranial hypertension which could be life-threatening, particularly peripartum. We report a case of a woman with intraventricular neurocysticercosis, who presented in the third trimester, and described the management dilemmas that were encountered. The differential diagnoses and other aspects of the medical and surgical management of neurocysticercosis in pregnancy are also discussed.
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Affiliation(s)
- Devika Ramesh
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Dilip K Maurya
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Madhavan S Gopalakrishnan
- Department of Neurosurgery, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Bhabani Pegu
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Ramesh Ananthakrishnan
- Department of Radio-diagnosis, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Pradeep P Nair
- Department of Neurology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Anish Keepanasseril
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
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Murrieta I, Flores X, Osorio R, Kuschick Feher J, Carrillo-Mezo R, Fleury A. Natural history of extraparenchymal neurocysticercosis. Trans R Soc Trop Med Hyg 2021; 115:1218-1225. [PMID: 33587139 DOI: 10.1093/trstmh/traa174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/07/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In patients affected by neurocysticercosis (NCC), the extraparenchymal location of the parasites generates the most severe form of the disease. Due to the difficulty in its diagnosis and management, there are still many questions; in particular, the natural history of parasites at this location is not well known. METHODS We included 21 patients with vesicular extraparenchymal NCC who had not received treatment for at least 18 months. We collected their demographic and clinical data, compared their imaging studies at the beginning and the end of the period without treatment and classified the patients, taking into account the evolution of their parasitic burden. RESULTS A total of 10 men and 11 women were included. Patients had undergone a period of 63±48 months without treatment. During this period, 8 patients (38.1%) showed an increase, 7 (33.3%) a decrease and 6 (28.6%) showed no change in parasite burden. CONCLUSION The natural history of extraparenchymal cysticerci is heterogeneous. The results show the ability of parasites to survive for a long time in the extraparenchymal location and explain the chronicity of the disease in some patients. The links between these findings and the difficulties in the therapeutic management of extraparenchymal NCC patients should be studied.
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Affiliation(s)
- Ilse Murrieta
- Neurocysticercosis Clinic, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México CP 14269, México
| | - Ximena Flores
- Neurocysticercosis Clinic, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México CP 14269, México
| | - Rocío Osorio
- Neurocysticercosis Clinic, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México CP 14269, México
| | - Jan Kuschick Feher
- Neurocysticercosis Clinic, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México CP 14269, México
| | - Roger Carrillo-Mezo
- Neuroradiology Department, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México CP 14269, México
| | - Agnès Fleury
- Neurocysticercosis Clinic, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México CP 14269, México.,Neuroinflammation Unit, Instituto de Investigaciones Biomédicas-Universidad Nacional Autónoma de México/INNN/Facultad de Medicina-UNAM, Ciudad de México CP 14269, México.,Medicina Genómica y Toxicología Ambiental department, Instituto de Investigaciones Biomédicas, Universidad Nacional Úutónoma de México, Ciudad Universitaria, Apartado postal 70228, Ciudad de México 04510, México
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Ursini T, Di Giacomo R, Caldrer S, Angheben A, Zammarchi L, Filipponi S, Pizio NR, Bisoffi Z, Buonfrate D. Neurocysticercosis-related seizures in the post-partum period: two cases and a review of the literature. THE LANCET. INFECTIOUS DISEASES 2020; 20:e204-e214. [PMID: 32569624 DOI: 10.1016/s1473-3099(20)30240-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 12/21/2022]
Abstract
Neurocysticercosis, the infection of the CNS with larval cysts of Taenia solium, is a leading cause of seizures in low-income countries. The clinical presentation of neurocysticercosis is variable and depends on the number, size, and location of cysticerci, and on the immune response of the host. In most patients, the affected site is the brain parenchyma, where cysts can precipitate seizures. Neurocysticercosis has seldom been described in pregnant women. In this Grand Round, we report two cases of pregnant women who immigrated to Italy from Bolivia and Ecuador, and who developed seizures in the early post-partum period, due to calcified parenchymal neurocysticercosis lesions. We discuss the complex interactions between neurocysticercosis and the immune system in pregnancy and the post-partum period. Building on this scenario, we propose practices for the management of neurocysticercosis in pregnancy and the post-partum period, highlighting important gaps in the literature that should be addressed.
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Affiliation(s)
- Tamara Ursini
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy.
| | - Roberta Di Giacomo
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Caldrer
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Andrea Angheben
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Referral Centre for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Stefania Filipponi
- Stroke Unit, Department of Neurological Disorders, Santa Chiara Hospital, Trento, Italy
| | | | - Zeno Bisoffi
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy; Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Dora Buonfrate
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
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Veloz A, Reyes-Vázquez L, Patricio-Gómez JM, Romano MC. Effect of mice Taenia crassiceps WFU cysticerci infection on the ovarian folliculogenesis, enzyme expression, and serum estradiol. Exp Parasitol 2019; 207:107778. [PMID: 31629698 DOI: 10.1016/j.exppara.2019.107778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/13/2019] [Accepted: 10/14/2019] [Indexed: 11/30/2022]
Abstract
The murine infection with Taenia crassiceps WFU (T. crassiceps WFU) cysticerci has been widely used as an experimental model to better understand human cysticercosis. Several reports have established that the host hormonal environment determines the susceptibility and severity of many parasite infections. Female mice are more susceptible to infection with T. crassiceps cysticerci suggesting that a rich estrogen environment facilitates their reproduction. Ovarian androgens and estrogens are synthesized by key enzymes as P450-aromatase and 17α-hydroxilase/17, 20 lyase (P450C17). The aim of this study was to determine the effect of chronic intraperitoneal infection of T. crassiceps WFU cysticerci on mice ovarian follicular development, ovulation, the expression of ovarian P450-aromatase and P450C17, and serum 17β-estradiol, key enzymes of the ovarian steroidogenic pathway. To perform this study ovaries and serum were obtained at two, four and six months from T. crassiceps WFU cysticerci infected mice, and compared to those of healthy animals. The ovaries were fixed and processed for histology or lysed in RIPA buffer for Western blot using specific antibodies for P450C17 and P450-aromatase. 17β-estradiol serum concentration was measured by ELISA. The results showed that the infection with T. crassiceps WFU cysticerci significantly reduced the number of primordial and primary follicles after two months of infection. Through the course of the study, the corpus luteum number began to decrease, whereas atretic follicles increased. The expression of ovarian P450C17 and P450-aromatase as well as serum E2 concentration were significantly increased in the infected group compared to control. These findings show that chronic infection with Taenia crassiceps WFU may alter the reproductive functions of the female mice host.
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Affiliation(s)
- A Veloz
- Departamento de Fisiología, Biofísica y Neurociencias, CINVESTAV del I.P.N, México CdMx, Mexico
| | - Liliana Reyes-Vázquez
- Departamento de Fisiología, Biofísica y Neurociencias, CINVESTAV del I.P.N, México CdMx, Mexico; Departamento de Toxicología, CINVESTAV del I.P.N., CdMx, Mexico
| | - J M Patricio-Gómez
- Departamento de Fisiología, Biofísica y Neurociencias, CINVESTAV del I.P.N, México CdMx, Mexico
| | - M C Romano
- Departamento de Fisiología, Biofísica y Neurociencias, CINVESTAV del I.P.N, México CdMx, Mexico.
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Saldanha V, Saldanha G, Reys RP, Benson CA, Noormahomed EV. Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia. EC MICROBIOLOGY 2018; 14:736-740. [PMID: 31681909 PMCID: PMC6824723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Several studies suggest that neurocysticercosis might be one of the main reasons for onset of seizures in adolescents and young adults in Mozambique, however, no studies have evaluated the burden and impact of the disease in women of childbearing age. This is also true for other parasitic diseases such as toxoplasmosis, toxocariasis and onchocerciasis, although the latter has been reported in some regions in central and northern Mozambique. We describe herein an 18 year old female who was admitted to Hospital Central de Quelimane, Zambézia Province in Mozambique, 8 days after delivery with a misdiagnosis of eclampsia that turned out to be neurocysticercosis. We discuss challenges in the diagnosis of neurocysticercosis in women of childbearing age and the potential for missed diagnosis in those who present with eclampsia and other conditions associated with seizures.
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Affiliation(s)
| | | | | | - Constance Ann Benson
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, USA
| | - Emília Virgínia Noormahomed
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, USA
- Department of Microbiology, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
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Padhy SK, Phuljhele S, Rathi A, Mandal S. Not just another diplopia: neurocysticercosis in a postpartum woman. BMJ Case Rep 2018; 2018:bcr-2018-227388. [PMID: 30366900 DOI: 10.1136/bcr-2018-227388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Srikanta Kumar Padhy
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Swati Phuljhele
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anubha Rathi
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sohini Mandal
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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