Otherwise A Healthy Man Found To Have An Anxious, Unexpected Visitor In His Brain

Three years ago, a family in Boston was thrown into chaos during the morning hours. A man who moments ago slept soundly next to his wife was on the floor convulsing, and no one knew why.

He was confused, uttering nonsensical words and tried to resist being taken by ambulance to Massachusetts General Hospital. There, through a laborious diagnostic process, doctors discovered an unwelcome brain guest.

Upon examination, the unfortunate man’s heartbeat and breathing were slightly elevated, but toxicology and thoracic X-rays showed no abnormalities. There was no physical evidence to suggest underlying chronic disease, no history of disease or unusual behavior in the lead up to the event, nor any known genealogy of neurological problems.

“The patient also had blood in his mouth, presumably from a bite of his tongue,” writes doctor Andrew Cole in a recently published case report.

The 38-year-old man was treated with lorazepam for the epileptic seizures, but it took even more work to find out what caused them in the first place.

Some conditions can lead to epileptic seizures or symptoms that look like them. Anything that disrupts blood flow to the brain can cause them, so it’s important to control the entire circulatory system. Tests revealed that the man’s liver, which regulates the chemicals in our bloodstream, and kidneys, which remove waste from the blood and regulate blood pressure, both worked properly.

Momentary blood loss to parts of the brain (ischemic attacks), drugs, migraines, and psychiatric events can also produce epilepsy-like symptoms, but the toxicology tests and the fact that the man was in perfect health before, ruled those out.

“Getting the medical history is key,” Cole explains. “The most powerful tool in assessing possible abduction is additional information.”

The patient’s history did provide evidence. He migrated from a rural area of ​​Guatemala 20 years ago.

MRI scans focusing on one of the three brain lesions (arrow). (Cole et al, NEJM, 2021)

Brain scans revealed three calcified lesions. Considering their presentation and the patient’s history, the doctors concluded that they were cysts belonging to the parasitic porcine tapeworm (Taenia solium). These white, ribbon-like worms rely on human hosts to reach the adult phase of their life cycle, where they cling to the small intestine with dozens of small hooks.

Here, the flatworms eat surrounding food and can grow to a shocking eight meters long. This is the stage they can reproduce sexually if they are lucky – otherwise they will reproduce asexually. Their eggs travel on our feces to the rest of the world. They can then survive in the environment for up to two months as eggs, in the hope of being eaten by another animal.

Pigs are the most common medium host, but sometimes other people or even the originally infected person eat the tapeworms, as well. They hatch in the intestines of their feeder and the resulting larva has made its way into the bloodstream, preferably to nest in delicious pork muscles that can then transport them back to people who have eaten undercooked meat.

However, the resulting cysts the larva can develop in any organ, and it is these that cause the most severe problems – especially if they establish themselves in the brain.

(Alexander J. da Silva / Melanie Moser / CDC)

This condition is called neurocysticercosis and it is the leading cause of acquired epilepsy in many parts of the world – including Latin America and sub-Saharan Africa. Thousands of people in the United States alone are thought to present cases not different from this one every year.

Neurocysticercosis is an preventable disease, but despite its prevalence and severity, relatively few resources have been devoted to combating it, leading the CDC to classify it as a neglected tropical disease.

Preventers include thorough hand washing, cooking and handling meat safely, and quick treatment for people with intestinal tapeworm.

Some cases of neurocystic heart disease require surgery to remove a problematic cyst from the brain, as in a recent case of a 25-year-old Australian woman who experienced constant headaches and blurred vision. Because the cysts can form in different parts of the brain, symptoms can vary greatly.

In this case, the man was treated with anti-inflammatory, anti-seizure and two anti-parasitic drugs. He was released from the hospital with no remaining symptoms after five days, and remains unharmed three years later.

However, he will probably have to continue taking the contraceptive medication.

“The issue of when to stop the medication is problematic because the calcified injury will stay on forever,” Cole says.

This case study was reported in The New England Journal of Medicine.

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