A 58-year-old patient with a history of recurrent headache was seen three times in the last 4 months in the Emergency Department.
With a first diagnosis of recurrent tension-type headache and successive migraine headaches, first step analgesic treatment was started as well as benzodiazepines and triptans adjuvants.
The patient presented again with a 7-day history of pulsatile hemicrane headache that did not respond to previous treatment.
It is accompanied by photophobia, nausea and vomiting.
The patient is born in Ecuador, lives in Spain for 7 years and traveled to his country a few months ago.
She currently works in agriculture and has not had contact with animals.
She denied toxic consumption.
As personal history highlights tuberculosis 20 years ago, which was treated in his country, and headache mixed type of years of evolution in treatment with analgesics, antidepressants, triptans and anxiolytics.
Complete neurological examination showed no abnormalities.
The eye fundus was normal and the visual field did not show significant alterations.
The rest of the examination was normal.
In the emergency analytics a discreet
Given the clinical features, a cranial computerized axial tomography (CAT) was performed, resulting in moderate hydrocephalia with triventricular predominance, with permeable IV and discrete transventricular exudate signs.
Extraaxial cystic dilatation in the right and suprasellar subarachnoid space.
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Gastroprotection and first, second and third step analgesics were prescribed in the Emergency Department with mild clinical improvement.
After the result of the CT and the refractory treatment, a consultation to Neurology was performed, indicating transfer of the patient to the reference hospital and admission to the service.
A battery of tests is done:
• Magnetic Resonance Imaging (MRI): findings compatible with a racemosa neurocysticercosis located in the fissure of the right temporal anterior Silvio, extending to the periscephalan in front of the trunk.
Increase in size of the third ventricle and laterals, with periventricular exudates, compatible with active hydrocephalia.
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• Orbital Doppler: signs of intracranial hypertension are observed.
• Simple radiography of both thighs (to rule out the presence of cysticerci at the muscle and subcutaneous levels): no muscle calcifications are seen.
• Positive cysticerc serology/PCR, confirming the diagnosis.
Treatment with corticosteroids in descending pattern and albendazole was initiated, with good response.
The patient did not require cerebrospinal fluid shunt.
