The neurocysticercosis puzzle: A case of chronic cephalalgia and hydrocephalus.

Neurocysticercosis (NC) is the most common helminthic CNS infection, primarily affecting individuals from endemic regions. We present the case of a 33-year-old Peruvian woman, who had been residing in Spain for over a decade, who experienced recurrent episodes of severe headache, vertigo, and diplopia. Initial evaluations revealed tetraventricular hydrocephalus with unclear etiology. Over the course of a year, she underwent multiple hospitalizations, being diagnosed with retinal toxoplasmosis. Serological testing revealed Taenia solium IgG antibodies. Despite inconclusive neuroimaging, she was treated with albendazole and corticosteroids, leading to symptom improvement. However, mild headaches persisted. Years later, a CT scan revealed a calcified cysticercus in the fourth ventricle, confirming the diagnosis of ventricular NC. This case underscores the diagnostic challenges of NC, particularly in atypical presentations. A multidisciplinary approach combining serology, neuroimaging, epidemiological risk assessment and clinical history is crucial for early detection and management. Long-term follow-up is essential to monitor sequelae and ensure optimal outcomes.