(077) Neurocysticercosis: A Unique Presentation of Depression and Homicidal Ideation

Location: Griffin Hall

Trainee Involvement: Yes

Presenting Author(s)

Dan Thompson, MD

Resident Physician
University of Virginia Health Systems
Charlottesville, Virginia, United States

Co-Author(s)

EF

Emily R. Fisher, MD MPH

Resident Physician
University of Virginia Health System
Charlottesville, Virginia, United States
AD

Anna Jane Davis, MD

Resident Physician
University of Virginia Health Systems
Charlottesville, Virginia, United States
PH

Pamila Herrington, MD

Associate Professor
University of Virginia Health Systems
Charlottesville, Virginia, United States

Neurocysticercosis is a parasitic infectious disease that occurs when larvae of the tapeworm Taenia solium invade neurologic tissue. While it is common for neurocysticercosis to present with neurologic symptoms or to remain asymptomatic, it rarely can present with psychiatric symptoms. We report the case of a 29 year old female with a known history of neurocysticercosis who had repeated psychiatric hospitalizations for depression, psychosis and intrusive thoughts to harm her children over the course of several months. She was treated with antidepressant and antipsychotic medications. After repeated psychiatric hospitalizations and lack of symptom remission, head imaging was pursued which revealed a large obstructive ventricular cyst, indicating recurrent active neurocysticercosis. She required urgent neurosurgical intervention and treatment with high dose steroids and antiparasitic medication. On review of the literature, this appears to be the first case of a patient with neurocysticercosis who developed intrusive thoughts to harm others. Furthermore, most reported psychiatric symptoms of neurocysticercosis present concurrently with neurologic symptoms, primarily in patients with known active disease. This unique case suggests that psychiatric symptoms may be the only manifestation of active neurocysticercosis. The decision to obtain CNS imaging in this patient’s care was in contrast to the standard evaluation of psychiatric symptoms, such that generally there is low utility to pursue head imaging. Therefore, in any patient with a prior diagnosis of neurocysticercosis, regardless of disease status, it may be prudent to observe a lower threshold to obtain head imaging for new onset or treatment-resistant psychiatric symptoms. Existing literature suggests that most antidepressant and antipsychotic medications can be used to treat psychiatric symptoms related to neurocysticercosis; this case supports those findings. Lastly, language barriers, financial difficulties, and medication nonadherence in this patient’s illness course illustrate the importance of a multidisciplinary approach and cultural competency in providing the highest standard of care.