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Step 1: View clinicals

A 59 year old migrant from India presents following a generalized tonic-clonic seizure around an hour ago, which was witnessed by his wife. The episode lasted for 2 to 3 minutes, following which he was confused for about 10 to 15 minutes. He was also incontinent of urine. No other symptoms were present. He has no medical conditions, does not drink, and denies substance abuse. An ECG, full blood count, random capillary glucose, and serum electrolytes are normal.

Step 2: Order all relevant investigations

CT Brain

A solitary nodule approximately 0.5 cm in diameter is noted in the right temporal lobe. No other abnormalities are present.

MRI Brain

There is a solitary cystic lesion 0.6 cm in diameter, in the right temporal lobe. T2 weighted images reveal perilesional edema, while contrast imaging with gadolinium reveals sharply defined ring enhancement of the lesion.

Lumbar Puncture

All indices within normal parameters. Cytology: No malignant cells. TB-PCR: negative ELISA for neurocysticercosis: positive

EITB for Anti-cysticercal Abs

The serum enzyme-linked immunoelectrotransfer blot (EITB) for anti-cysticercal antibodies is positive.

Step 3: Select appropriate management

VP-Shunt Placement

Score: ★★☆