Doğum sonrası nörosistiserkoz: subdural hematom ile seyreden tanısal zorluk

Öz

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.

Anahtar Kelimeler

• Nörosistiserkoz
• subdural hematom
• parazitik enfeksiyon

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

Öz

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.

Anahtar Kelimeler

• Neurocysticercosis
• subdural hematoma
• parasitic infections

Kaynakça

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