///2010 Abstract Details
2010 Abstract Details2018-05-01T17:52:49+00:00

Repeat Cesarean Section in a Parturient with Neurocysticercosis and Progressive Neurological Symptoms

Abstract Number: 146
Abstract Type: Case Report/Case Series

James R Dyer MD1 ; Benjamin Pitman MD2; Gustin Bateman MD3

Introduction: Neurocysticercosis (NCC) caused by the pork tapeworm Taenia Solium has increased in prevalence in the USA due to immigration.(1) Clinical manifestations vary based on the size and location of the lesions and the host response. Symptoms may be confused with more common conditions such as eclampsia(2) or post-dural puncture headache after regional anesthesia.(3) We present a case of a parturient with symptomatic NCC presenting for repeat CS.

Case: A 26 year old G2P1 parturient from Mexico was seen prior to elective repeat CS at 38 weeks gestation. She was diagnosed with NCC two years prior to admission at another institution after a generalized siezure. At 32 weeks gestation she developed headache, blurred vision, double vision, myodeopsia (floaters) and nausea. She denied fever, chills, night sweats or weakness and had no evidence of preeclampsia. Fundoscopic exam by an ophthalmologist was normal with no evidence of papilledema or ocular cysticercosis. She went into labor prior to repeat imaging of her brain. CS via general endotracheal anesthesia with propofol, lidocaine, fentanyl, succinylcholine, morphine, low dose isoflorane, air and oxygen was performed without complications. Normocapnia was maintained throughout surgery and she was extubated awake while minimizing cough. Vasopressors were not needed. Postoperatively she continued to have a severe headache and nausea without fever, meningismus, or focal neurological signs. Inpatient brain MRI and neurology consultation were pending at time of abstract submission.

Discussion: Clinical symptoms of NCC vary based on size and location of the lesions and host response. The most common clinical presentation of NCC is seizures from parenchymal lesions. Brain CT or MRI may demonstrate calcifications. (1) Although headaches are common in the postpartum period, a progressive headache in a patient with NCC requires further investigation to rule out mass effect, hydrocephalus, or meningoencephalitis. While we were reassured by the absence of papilledema on fundoscopic exam, our patients progressive neurological symptoms warranted brain imaging, however, this was not done prior to onset of labor. Because her airway was favorable and the extent of her intracranial pathology was unknown, we opted for general rather than regional anesthesia. Our goals included maintaining cerebral perfusion pressure and avoiding techniques that would increase intracranial pressure. Knowledge of the parenchymal and extraparenchymal complications of NCC facilitated the development of a safe anesthetic plan despite the diagnostic uncertainty. Outstanding considerations included diagnosis and treatment of her acute neurological process and definitive treatment of her underlying parasitic infection.

References:

1. Surgical Neurology 2005;63:123-32.

2. Anesthesiology 2006;105(5):1056-1057.

3. Anes Analg 2003;97:580-2.

SOAP 2010