Neurocysticercosis — DTM&H MCQ

Correct answer: A — Neurocysticercosis

The correct answer is A, neurocysticercosis. In a child from a pig-farming area in an endemic region presenting with new-onset seizure, multiple cystic brain lesions each containing an eccentric hyperdense nodule (the scolex) on CT are pathognomonic for neurocysticercosis, caused by larval Taenia solium invading the CNS. Humans acquire this by ingesting T. solium eggs (faeco-oral route, often from a tapeworm carrier in the household), not directly from pigs; the pig-farming context simply signals the endemic exposure risk, since pigs are the intermediate host that maintain the parasite's lifecycle. Neurocysticercosis is recognised as the leading cause of acquired epilepsy worldwide, and the combination of seizures plus this specific imaging pattern in an endemic-exposure setting is the classic exam vignette. Management includes antiepileptics, corticosteroids to control the inflammatory response, and albendazole (sometimes with praziquantel) for viable cysts. Why the other options are wrong: B. Cerebral malaria: causes diffuse encephalopathy with petechial haemorrhages and cerebral oedema on imaging, not discrete cystic lesions with scolices, and there is no travel or exposure history suggesting Plasmodium falciparum infection here. E. Echinococcal cyst: hydatid cysts from Echinococcus granulosus are typically large, unilocular, well-defined fluid-filled cysts without an internal scolex nodule visible on CT, and are linked to dog/sheep exposure rather than pigs. C. Cerebral toxoplasmosis: produces ring-enhancing lesions with oedema, almost exclusively in immunocompromised hosts (e.g. HIV), and lacks the calcified scolex appearance described. D. Tuberculoma: presents as a solitary or few conglomerate enhancing granulomas, usually without the eccentric nodular scolex, and is associated with pulmonary TB exposure rather than pig contact. Key point: multiple cystic brain lesions with an eccentric hyperdense scolex on CT, in a patient with pig-related or faecal-oral exposure risk, is diagnostic of neurocysticercosis and the top cause of acquired epilepsy in endemic regions.

Reference: British National Formulary (BNF), Albendazole, Indications and dose: treatment of neurocysticercosis, NICE BNF, https://bnf.nice.org.uk/drugs/albendazole/