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The worms that invade your brain

Published online by Cambridge University Press:  13 August 2021

G. Marinho*
Affiliation:
Clinica 6, CHPL, Lisbon, Portugal
J. Peta
Affiliation:
Psychiatry, Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
S. Vieira
Affiliation:
Clinica 6, CHPL, Lisbon, Portugal
M. Marguilho
Affiliation:
Clínica 5, Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
*
*Corresponding author.

Abstract

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Introduction

Neurocysticercosis is a parasitic infection of the central nervous system and caused by the pork tapeworm Taenia solium. Humans become infected after consuming undercooked food or water contaminated with tapeworm eggs, or through poor hygiene practices. The clinical manifestations of neurocysticercosis (NCC) largely depend on the number, type, size, localization, and stage of development of cysticerci, as well as on the host immune response against the parasite. Seizures are the most common manifestations of NCC (70–90%) of patients, followed by headache (38%), focal deficits (16%) and signs of intracranial hypertension (ICH) (12%), but psychiatric symptoms can also be seen.

Objectives

Literature review on neuropsychiatric manifestations of neurocysticercosis, based on a clinical case.

Methods

Pubmed search using the keywords neurocysticercosis, psychiatric comorbidity, neuropsychiatric manifestations.

Results

We present a clinical case of a 29-year-old male patient, with history of an epilepsy, that immigrated to Portugal with his family from Cape Verde for specialized medical care. He presented to the ER with an acute psychotic episode characterized by disorientation, persecutory ideation, psychomotor agitation and violent behavior. Brain CT scan showed multiple calcifications in cerebral parenchyma and CSF was positive for antibodies against T. solium.

Conclusions

The polymorphous symptomatology seen in NCC is mimicked only by neuro-tuberculosis and neurosyphilis in developing countries, and multiple sclerosis in the Western countries. Psychiatric symptoms are a part of the clinical presentation of infectious diseases. It is important to consider NCC in endemic areas presenting with psychiatric symptoms, especially those showing poor response to the standard treatment and in those with history of seizures.

Disclosure

No significant relationships.

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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