Doğum sonrası nörosistiserkoz: subdural hematom ile seyreden tanısal zorluk

Abstract

Neurocysticercosis, insanlarda merkezi sinir sisteminin en yaygın paraziter enfeksiyonudur ve Taenia solium’un larval formunun neden olduğu bir hastalıktır. Klinik belirtileri oldukça geniş bir yelpazede değişkenlik gösterebilir; asemptomatik olgulardan nöbetlere, fokal nörolojik defisitlere ve artmış kafa içi basınca kadar uzanabilir. Doğum sonrası dönem, enfeksiyon hastalıklarının ortaya çıkışını, seyrini ya da klinik tablosunu etkileyebilecek önemli immünolojik, hormonal ve metabolik değişikliklerle karakterizedir. Bu yazıda, doğum sonrası dönemde subdural hematom şeklinde ortaya çıkan nadir bir neurocysticercosis vakası sunulmaktadır. Önceden bilinen bir hastalık öyküsü olmayan yirmi bir yaşındaki kadın hasta, sezaryen doğumdan otuz beş gün sonra şiddetli baş ağrısı ve konuşma bozukluğu şikayetleri ile başvurdu. Beyin bilgisayarlı tomografisinde sol tarafta on beş milimetre kalınlığında subdural hematom ve yedi milimetre orta hat kayması saptandı. Acil kraniyotomi ile hematom boşaltıldı. Cerrahi örneğin histopatolojik incelemesi, Taenia solium’un larval formunu göstererek neurocysticercosis tanısını doğruladı. Ameliyat sonrası dönemde hastada nöbetler gelişti ve antiepileptik tedavi artırıldı. Albendazol ve kortikosteroid içeren antiparaziter tedavi başlandı. Beyin ve omuriliğin manyetik rezonans görüntülemesinde başka kistik lezyon saptanmadı. Hasta tedaviye olumlu yanıt verdi ve yirmi üçüncü günde hafif konuşma bozukluğu ile taburcu edildi. Bir ay sonraki kontrolde nörolojik muayenesi tamamen normaldi. Bu olgu, doğum sonrası dönemde nadir bir neurocysticercosis sunumu olarak dikkat çekmektedir ve endemik bölgelerde nöbet veya subdural hematomla başvuran kadınlarda ayırıcı tanıda düşünülmelidir.

Keywords

• Nörosistiserkoz
• subdural hematom
• parazitik enfeksiyon

Neurocysticercosis presenting as a subdural hematoma in the postpartum period: a diagnostic challenge

Abstract

Neurocysticercosis is the most common parasitic infection of the human central nervous system, caused by the larval stage of Taenia solium. Its clinical manifestations vary widely, ranging from asymptomatic cases to seizures, focal neurological deficits, and increased intracranial pressure. The postpartum period involves significant immunological, hormonal, and metabolic changes that may influence the onset, progression, or presentation of infectious diseases. This report presents a rare case of neurocysticercosis presenting as a subdural hematoma during the postpartum period. A twenty-one-year-old woman with no previous medical history was admitted thirty-five days after cesarean section due to severe headache and speech impairment. Cranial computed tomography revealed a left-sided subdural hematoma measuring fifteen millimeters in thickness, associated with a seven-millimeter midline shift. The patient underwent emergency craniotomy to evacuate the hematoma. Histopathological examination of the surgical specimen confirmed the presence of the larval form of Taenia solium, thereby establishing the diagnosis of neurocysticercosis. Following surgery, the patient experienced seizures, which required intensified antiepileptic medication. Antiparasitic treatment consisting of albendazole and corticosteroids was initiated. Further radiological evaluations, including cranial and spinal magnetic resonance imaging, did not identify any additional cystic lesions. The patient responded well to treatment and was discharged on hospital day twenty-three with mild speech impairment. At the one-month follow-up visit, her neurological examination was entirely normal. This case highlights an unusual presentation of neurocysticercosis in the postpartum period and underscores the importance of considering this diagnosis in patients presenting with seizures or subdural hematoma in endemic regions.

Keywords

• Neurocysticercosis
• subdural hematoma
• parasitic infections

References

1. Sciutto E, Fragoso G, Fleury A, et al. Taenia solium disease in humans and pigs: an ancient parasitosis disease rooted in developing countries and emerging as a major health problem of global dimensions. Microbes Infect. 2000;2(15):1875-1890. doi:10.1016/s1286-4579(00)01336-8
2. Martinez HR, Rangel Guerra R, Arrendo Estrada JH, Marfil A, Onofre J. Medical and surgical treatment in neurocysticercosis: A magnetic resonance study of 161 cases. J Neurol Sci. 1995;130(1):25-34. doi:10.1016/0022-510x(94)00278-v
3. Garcia HH. Neurocysticercosis. Neurol Clin. 2018;36(4):851-864. doi:10.1016/j.ncl.2018.07.003
4. Xiao A, Xiaao J, Zhang X, You C. The surgical value of neurocysticercosis: Analyzing 10 patients in 5 years. Turk Neurosurg. 2016;26(5):744-749. doi:10.5137/1019-5149.JTN.11672-14.1
5. Steyn TJS, Awala AN, de Lange A, Raimondo JV. What causes seizures in neurocysticercosis? Epilepsy Curr. 2023;23(2):105-112. doi:10.1177/15357597221137418
6. WHO Taenia solium endemicity map – 2022 update. Weekly Epidemiological Record. Available at: https://www.who.int/publications/i/item/who-wer9717-169-172. Accessed August 24, 2025
7. Haddad N, Shaheen Y, Abunaib M, et al. Neurocysticercosis in non-endemic regions: The experience of Qatar. Front Neurol. 2023;14:1173909. doi:10.3389/fneur.2023.1173909
8. Ursini T, Giacomo RD, Caldrer S, et al. Neurocysticercosis-related seizures in the post-partum period: Two cases and a review of the literature. Lancet Infect Dis. 2020;20:e204-214. doi:10.1016/S1473-3099(20)30240-1

9. Feinberg WM, Valdivia FR. Cysticercosis presenting as a subdural hematoma. Neurology. 1984;34(8):1112-1113. doi:10.1212/wnl.34.8.1112
10. Im SH, Park SH, Oh DH, Kang BS, Kwon OK, Oh CW. Subdural cysticercosis mimicking a chronic subdural hematoma: Case illustration. J Neurosurg. 2005;102(2):389. doi:10.3171/jns.2005.102.2.0389
11. Rajshekhar V. Cerebral cysticercus granuloma associated with a subdural effusion. Neurol India. 2001;49(2):182-184
12. Garcia HH, Nash TE, Del Brutto OH. Clinical symptoms, diagnosis, and treatment of neurocysticercosis. Lancet Neurol. 2014;13(12):1202-1215. doi:10.1016/S1474-4422(14)70094-8
13. Viola GM, White AC Jr, Serpa JA. Hemorrhagic cerebrovascular events and neurocysticercosis: a case report and review of the literature. Am J Trop Med Hyg. 2011;84(3):402-405. doi:10.4269/ajtmh.2011.10-0429
14. Edlmann E, Giorgi Coll S, Whitfield PC, Carpenter KLH, Hutchinson PJ. Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation. 2017;14(1):108. doi:10.1186/s12974-017-0881-y
15. White AC Jr, Coyle CM, Rajshekhar V, et al. Diagnosis and Treatment of Neurocysticercosis: 2017 Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis. 2018;66(8):e49-e75. doi:10.1093/cid/cix1084
16. Peralta F, Devroe S. Any news on the postdural puncture headache front? Best Pract Res Clin Anaesthesiol. 2017;31(1):35-47. doi:10.1016/j.bpa.2017.04.002
17. Moore AR, Wieczorek PM, Carvalho JC. Association between post–dural puncture headache after neuraxial anesthesia in childbirth and intracranial subdural hematoma. JAMA Neurol. 2020;77(1):65-72. doi:10.1001/jamaneurol.2019.2995
18. Zeidan A, Farhat O, Maaliki H, Baraka A. Does postdural puncture headache left untreated lead to subdural hematoma? Case report and review of the literature. Int J Obstet Anesth. 2006;15(1):50-58. doi:10.1016/j.ijoa.2005.07.001
19. Amorim JA, Remigio DS, Damazio Filho O, de Barros MA, Carvalho VN, Valenca MM. Intracranial subdural hematoma post-spinal anesthesia: report of two cases and review of 33 cases in the literature. Rev Bras Anestesiol. 2010,60(6):620-629. doi:10.1016/S0034-7094(10)70077-5
20. Webbe G. Human cysticercosis: Parasitology, pathology, clinical manifestations and available treatment. Pharmacol Ther. 1994;64(1):175-200. doi:10.1016/0163-7258(94)90038-8
21. Del Brutto OH. Diagnostic criteria for neurocysticercosis, revisited. Pathog Glob Health. 2012;106(5):299-304. doi:10.1179/2047773212Y.0000000025