An unusual presentation of neurocysticercosis as psychosis with tics

Abstract

Neurocysticercosis (NCC) is an infection caused by the larval stage of the parasite, Taenia solium. Seizures, psychosis, Parkinsonism, and other movement disorders have been described in the literature pertaining to NCC; however, no reports were available on tics. A young female presented to the outpatient department with headache, psychotic symptoms, and tics for a duration of 15–20 days. On examination, she was noted to have fluctuating orientation and was hypervigilant. She also presented with irrelevant speech, ideational perseveration, paranoid ideation, visual/auditory hallucinations, and motor/vocal tics. Following a detailed evaluation with investigations such as magnetic resonance imaging of the brain and ELISA, a diagnosis of NCC with psychosis and tics was made. She was treated with mannitol, steroids, albendazole, and antipsychotics. Psychosis and tics improved within 1 week of treatment. This case highlights an uncommon presentation of NCC as well as the significance of a high index of suspicion and the need for a careful workup to catch these cases.

Keywords

• movement disorders
• neurocysticercosis
• psychosis
• tics