Neurocysticercosis presenting as pseudobulbar palsy
A 38-year-old female patient presented with progressive dysarthria, dysphagia, nasal regurgitation and hyper nasal speech for 5 months duration. She had 4 episodes of partial seizures involving the right upper and the lower limb for the past 5 months and was not on any medications. There was weakness of the left upper limb for the past 15 days duration but there was no headache, vomiting or blurring of vision. She had emotional instability in the form of inappropriate crying. Neurological examination showed exaggerated jaw jerks and gag reflex with spastic dysarthria. She had both proximal and distal weakness in the left upper limb with power of 3/5. All the deep tendon reflexes were brisk with plantar response mute bilaterally and cortical sensory loss in the left upper limb. There was no atrophy or fasciculation of the affected muscles. The fundus and other system examination were normal.\nLaboratory examination revealed positive neurocysticercosis serology. The peripheral smear was normal. The renal and liver function tests were normal. The MRI brain showed multiple small cysts with scolex in both the cerebral hemispheres and a giant intraparenchymal cyst measuring 5 × 4.3 cms in the right cerebral hemisphere [Figure and ].\nOur patient presented with pseudobulbar palsy, partial seizures and weakness of the left upper limb. Her NCC serology was positive and diagnosis confirmed by MRI, which showed multiple cysts with scolex (in vesicular stage). She received the treatment with albendazole at 15 mg/kg/day along with steroids (for two weeks). She also received phenytoin for seizures. The patient remained seizure free and there were no significant events during her hospital stay. On follow-up six weeks after the completion of albendazole therapy she reported no recurrence of seizures and her right upper limb weakness recovered partially with power of 4/5. There was also improvement in her speech, emotional instability and was able to take food without nasal regurgitation.