ABSTRACT
Key Clinical Message: In patients with appropriate epidemiological risk factors, neurocysticecosis should be considered as part of the differential diagnosis of suprasellar or parasellar mass lesions. As neuroimaging findings can be nonspecific, serology may be helpful, but when still in doubt, brain biopsy, and histopathology may be necessary to make the correct diagnosis. Abstract: Neurocysticercosis (NCC) is a well-documented central nervous system helminth infection that is, frequently observed in developing countries. Known sites of NCC infection include the highly vascular gray-white matter junction, basal cistern, brain parenchyma, subarachnoid space, ventricular system, and spinal cord. This case highlights an uncommon yet intriguing site of NCC infection within the suprasellar area, which presented with similar clinical and imaging characteristics as suprasellar masses or lesions. The 44-year-old female initially complained of headaches and nausea that persisted for 5 years and progressed to vision problems and short-term memory loss. A craniopharyngioma was initially suspected, based on imaging findings of a partially calcified suprasellar tumor. However, cysticercosis was confirmed by histopathology and serological testing positive for Cysticercus IgG antibodies. The patient was successfully treated with albendazole and tapering doses of steroids, which improved her presenting symptoms and resolved prior imaging findings. This case serves as a reminder to consider NCC in the differential diagnosis of sellar and suprasellar masses or lesions, particularly when an epidemiologic risk factor is present.
ABSTRACT
Bariatric surgery is an established treatment option for patients with non-alcoholic fatty liver disease (NAFLD) as well as non-alcoholic steatohepatitis (NASH) and is said to effectively reduce hepatic inflammation as well as steatosis in these patients. However, bariatric surgery is associated with multiple complications, including nutritional deficiencies, malnutrition, post-bariatric hypoglycemia (PBH), anastomotic leaks, and bowel strictures. This case report describes a rare but significant complication of post-bariatric surgery hypoglycemia in a patient with NASH, which started almost six months after Roux-en-Y gastric bypass (RYGB) surgery. This 55-year-old male patient presented with recurrent episodes of severe hypoglycemia, which, on further work-up, were found to be predominantly nocturnal as well as occurring two to three hours after meals. We report the successful treatment of the patient with an unconventional approach using nifedipine and acarbose. Our findings emphasize the importance of careful evaluation of patients who have undergone bariatric surgery, as this complication can occur as early as six months following the bariatric surgery as well as several years after the surgery. Our case report highlights the need for early recognition, relevant workup, and appropriate management of resistant hypoglycemic events using calcium channel blockers and acarbose, thus adding to the existing literature on this topic.
