Neurocysticercosis and Psycho-social Trauma

This chapter describes a patient with neurocysticercosis who presented with psychotic features. He
came to Cairns, Queensland, Australia as a refugee following his experiences of civil unrest in
Rwanda. A review of the current literature on neurocysticercosis is described including an
introduction, clinical presentation of neurocysticercosis, diagnosis, treatment, case presentation,
clinical course, Axis 1-IV diagnoses and discussion highlighting psychosocial trauma. A history of the
genocide he survived in Rwanda in 1994 is summarised along with a discussion of traumatic or
dissociative psychosis that was included in his differential diagnosis. The patient was admitted
through the Emergency Department where he was assessed and treated in a medical ward with the
involvement of the Psychiatric Liaison Team and Infectious Disease Team. CT and MRI of the brain
confirmed the diagnosis of neurocysticercosis. Medical treatment was administered for
neurocysticercosis and community psychiatric and medical follow-up were undertaken.
Medical treatment of neurocysticercosis was successful but the patient subsequently developed a
seizure disorder that was treated effectively and subsequently resolved without the need for
continuing medication. The patient’s psychotic disorder was treated with medication and supportive
psychotherapy. His delirium cleared quickly after two days treatment with an antipsychotic was given.
Unresolved grief related to psycho-social trauma was addressed as an on-going process during his
community psychiatric treatment.
Neurocysticercosis is rare and should be considered in immigrants from countries that have endemic
neurocysticercosis. A small minority of patients present with psychosis. This patient who survived
extensive trauma presented with psychosis that required assessment for traumatic or dissociative
psychosis.