Abstract:

A 53-year-old male patient, who is a farmer, lived in Tanchang of Gansu, was treated at the Neurology Clinic of Gansu Provincial People’s Hospital due to “headache, dizziness, nausea, and vomiting for one week” on November 19, 2021. On admission, CT plain scan of the brain showed nodular and slightly high-density lesions in the transparent septum, while MRI of the head showed mild ventricular dilation. Lumbar puncture result showed that the intracranial pressure was 180 mmH₂O (1 mmH₂O = 9.779 Pa). The cerebrospinal fluid laboratory examination showed that the total protein in cerebrospinal fluid was 0.74 g/L. The second lumbar puncture result showed that the intracranial pressure was 300 mmH₂O and the patient was transferred to neurosurgery on the following day. The patient was drowsy with high cranial pressure and unable to speak correctly upon awakening. Repeat CT scan showed lateral ventricular dilatation, which suggested high risks of hydrocephalus and cerebral hernia. The patient had eaten undercooked meat in recent years and a history of liver echinococcosis. To reduce patient’s cranial pressure, ventriculocentesis was performed on November 26 and the patient got the intensive care after surgery. The serum samples were positive for cysticercosis IgG and Toxoplasma gondii IgG. Therefore, the patient was treated with praziquantel (400 mg/8 h) and albendazole (0.4 g/d) for 3 courses (7 d/course, each treatment interval of 5 d). Endoscopic third ventriculostomy (ETV) was performed for the hydrocephalus on December 13. The patient got the antiparasitic therapy after ETV and lumbar ampullary drainage was performed at the same time, but the condition was not improved. The ventriculocentesis was performed twice on December 28 and January 11, 2022 respectively to reduce patient’s cranial pressure. The patient was treated with antiparasitic therapy and tigecycline (50 mg/12 h) and sulperazon (3 g/8 h). The patient’s intracranial infection indicators turned negative on January 25 and enhanced brain MRI showed no obvious tapeworm lesions. Laparoscopic assisted ventriculoperitoneal shunt was performed on January 27. The patient’s was consciouse and the cranial CT scan showed improved hydrocephalus after the surgery. The patient was discharged from the hospital with clear consciousness and no obvious dizziness, headache, nausea, vomiting or seizures on February 11. The patient recovered well after 3 months.

Key words: Neurocysticercosis, Intraventricular, Hydrocephalus, Intracranial infection