Caught in the act: migrating intraventricular neurocysticercosis causing intermittent unilateral hydrocephalus due to foramen of Monro obstruction

Excerpt

A 53-year-old male with known neurocysticercosis (NCC) diagnosed radiologically, presented with sudden onset of severe headache and vomiting. Patient was on antihelminthic treatment at the time of admission. Previous MRI (done around 4 months earlier) had shown an intra-ventricular cyst in the posterior body of the left lateral ventricle (Fig. 1a). In addition, there were multiple cysticercus cysts in different stages, in subarachnoid and parenchymal locations, involving supra and infra tentorial compartment. MRI on admission showed that the intra-ventricular cysticercus cyst had migrated and was obstructing the left foramen of Monro causing dilatation of the left lateral ventricle with surrounding periventricular interstitial edema (Fig. 1b). The patient was advised urgent ventricular drainage but was not keen on undergoing a surgery; so reluctantly antihelminthics were continued and close follow-up was suggested. The follow-up MRI after 10 weeks showed that the cyst had dislodged from the left foramen of Monro and was now seen to lie in the mid body of the left lateral ventricle. The left ventricular dilatation along with periventricular edema had resolved. The cyst was also smaller in size (Fig. 1c). The three-dimensional constructive interference in the steady state (3D-CISS) sequence distinctively demonstrated the cyst to be obstructing the left foramen of Monro (Fig. 2a).

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