Diagnostic dilemma: Neurocysticercosis—a differential diagnosis for seizures in pregnancy and early postpartum period

Abstract

The most common helminthic infestation of the brain worldwide is neurocysticercosis (NCC). When a woman presents with seizures during pregnancy, eclampsia is the go to provisional diagnosis. NCC may be misdiagnosed because of its symptoms like headache, vomiting and nausea, neurological and visual disturbances, and seizures. Hence, radiological findings help to diagnose NCC. Treatment is with antiepileptics and antihelminthic agents. We reported the cases of three Indian women in our tertiary care center, aged 19, 20, and 22 years, respectively, with NCC, one of whom presented with seizures in the first trimester of pregnancy and other two during the postpartum period. All patients were normotensive with urine albumin nil and no history of increased blood pressure in the past. The confirmation was done on the basis of MRI brain, which showed spherical ring-enhancing lesions that were calcified in the brain. In the first patient aged 19 years, pregnancy was terminated on patient request and she was discharged on albendazole and levetiracetam. The second and the third patients whose antenatal period was uneventful with postpartum convulsions were also put on levetiracetam and albendazole for 21 days.