Atypical presentation of neurocysticercosis suggestive of the racemose variant: a case report

Abstract Introduction Racemose neurocysticercosis often presents atypically as compared to its parenchymal counterpart. Diagnosis is challenging due to nonspecific clinical features and limited access to confirmatory investigations in resource-limited settings. Case description We report a case of a middle-aged man who presented with a history of headache, vomiting, and seizures followed by slurred speech and dysmetria, which later progressed to hemiparesis and aphasia. Computed tomography revealed multiple large cystic lesions in the left frontal, temporal, and parietal lobes with mass effect. Magnetic resonance imaging was unavailable at the presentation. A neurosurgical stereotactic biopsy confirmed neurocysticercosis. The patient initially improved on albendazole and corticosteroids but relapsed a year later with new neurological deficits, suggesting racemose neurocysticercosis. Discussion Our case highlights the diagnostic and therapeutic challenges of racemose neurocysticercosis and the need for heightened clinical suspicion, timely neuroimaging, histopathological confirmation, and aggressive treatment strategies in low-resource settings.