Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.. days with albendazole and for 10 days with dexamethasone. His headaches and fevers resolved, and he was discharged home on day 7 of hospitalization. At the 2-week follow-up, his gait and strength had returned to normal, although his left lower-extremity reflexes were still brisk (3+). Results of his neurologic examination had normalized completely by the 10-week follow-up visit. Repeat MRI of the brain 1 month after completion of treatment revealed decreased size of the prepontine cyst and improvement of the thalamic lesion. Teaching Points Diseases caused by include Brompheniramine taeniasis (adult tapeworm), associated with the ingestion of raw or undercooked infected pork, and cysticercosis (encysted larvae), associated with the ingestion of food contaminated with egg-containing fecal matter from infected animals or humans [2]. As in this case, the ingestion of pork is not required for the development of cysticercosis. In those with cysticercosis, after intestinal penetration and hematogenous spread, the embryo anchors in terminal vessels of end organs, most notably the brain [3]. The encysted lesions cause little inflammation initially; however, with involution of the cysticercus, inflammation and edema Brompheniramine can occur. Calcification ultimately can follow complete involution [4]. Infected people can be asymptomatic and afebrile for years; sometimes calcified cysticerci are found incidentally in neuroimaging studies [3]. However, as seen in this patient, some cysticerci will cause inflammation as they mature and degenerate, which leads to slow-onset headache and/or Brompheniramine seizure [2]. In fact, neurocysticercosis is the most common Brompheniramine cause of acquired epilepsy in countries in which cysticercosis is endemic [2]. Complications include cranial nerve palsy, ophthalmologic complaints, intracranial hypertension, hydrocephalus, and stroke. Despite poor reported specificity [3], the diagnosis of neurocysticercosis remains primarily radiographic. Calcifications can be seen with computed tomography scans; however, contrast-enhanced MRI might identify cysts (with laminar scolex), calcifications, or related edema [4], so imaging is typically recommended when neurocysticercosis is suspected. Peripheral eosinophilia is uncommon; however, eosinophilic pleocytosis of the CSF suggests extraparenchymal cysticerci, as seen in this patient and in up to 30% of patients with neurocysticercosis [3]. Antigen testing is unreliable, because circulating serum antigens are transient, and stool antigen testing depends on disease burden [4]. Positive serum antibody results indicate exposure to the organism but do not indicate timing of infection, whereas intrathecal production of antibody detected in CSF confirms neuroinvasive infection [4]. However, false-negative serologic testing results are found in up to 50% of people with just 1 cyst or calcifications alone [4]. In this patient, the eosinophilic CSF pleocytosis and cystic mass with mural nodule Brompheniramine made cysticercosis the most likely diagnosis, although it was important to consider cryptococcal infection with the thalamic findings. Treatment was started empirically once cryptococcal testing results were found to be negative, pending confirmatory studies. Specific polymerase chain reaction testing of the CSF might play a role in definitively diagnosing [3], but it is directed at only 1 1 target and might lack sensitivity. Metagenomic sequencing is an emerging diagnostic approach that enables comprehensive identification of potential pathogens in a single assay through the detection of nucleic acid from viruses, bacteria, fungi, and parasites [5]. This case reveals how this unbiased approach might be used to identify or confirm a diagnosis in cases of unexplained meningoencephalitis. Once a patient is diagnosed with neurocysticercosis, treatment Rabbit polyclonal to AMID includes albendazole for 14 days as a first-line antiparasitic treatment with concurrent corticosteroids to control the inflammatory reaction from host recognition of the parasite as it dies [2, 4]. In addition, anticonvulsant agents can be used to control or prevent seizures caused by edema from your inflammatory response. Overall, the prognosis of individuals with neurocysticercosis depends on many factors, including disease burden, cyst location, and host immune response. Intraparenchymal disease typically is definitely resolved, although some individuals encounter long term headaches and seizures. In individuals with extraparenchymal disease, lesions.