Finding the hidden-cerebellopontine angle neurocysticercosis
Published in the Journal of The Association of Physicians of India, the authors present a patient, of new daily persistent headache (NDPH) with normal initial CT and MRI scan of head, who later was found to have cerebellopontine angle region Neurocysticercosis (NCC).

A 30-year-old reported with complaint of headache for a about a month, initially, the headache, which was frontotemporal in location, would occur daily at any time of the day and was moderate to severe in intensity, and would last few hours. For the previous 15 days he described his headache being located at frontal and occipital regions and would occur at waking hours.

Noncontrast CT scan of his head was unremarkable. He declined consent for lumbar puncture. In view of absence of red flag symptoms and signs, we prescribed oral prochlorperazine and propranolol along with analgesics and asked him to be under close follow up. At a follow up visit on he reported complete resolution of his headache with no new symptoms. Three days later, that is on he reported new symptoms of sudden onset double vision and right ear fullness.

His otoscopic and other ear related clinical examination was within normal limits. Neurological examination was remarkable for nystagmus in right horizontal gaze. Rest of his general and systemic examination was unremarkable. His complete blood count erythrocytic sedimentation rate, routine blood biochemistry, X-ray chest, tests for antinuclear antibody and human immunodeficiency virus were within normal limits.

Fresh Contrast enhanced MRI scan of his brain revealed two coalescing ring enhancing lesions in right cerebellar pontine angle region. A presumptive diagnosis of neurocysticercosis (NCC) was made and he was administered oral deflazacort and albendazole for a period of three weeks. At a follow up visit he reported total resolution of his symptoms.

Key takeaways:-
• Cysticercus can produce headache by two mechanisms. One, by obstructing the flow of cerebrospinal fluid and producing hydrocephalus.

• Two, when pain producing structures are irritated by the inflammation that occurs when viable cyst transforms into granulomatous stage.

• Since in this case imaging studies did not reveal any hydrocephalus, so it must have been the early inflammation of transition phase between viable cyst and granulomatous stage irritating some pain producing structure that was responsible for the initial new daily persistent headache (NDPH).

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