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/ Source: TODAY
By A. Pawlowski
Rachel Palma's symptoms were strange and disturbing: She had hallucinations, insomnia and "awful nightmares". Her right hand would suddenly disappear and she would lose things. She had trouble finding the right words and making alarming phone calls to her family she couldn't remember.
"My episodes became increasingly bizarre," Palma, 42, living in Middletown, New York, told TODAY. "There were days when I didn't know where I was."
She had been in acute care several times after the trouble started early last year, but the cause remained a mystery. Finally, an MRI scan of her head caught the doctors' attention: It showed a lesion on the left side of her brain, which was almost the size of a marble.
The left side of the brain in right-handed people controls language and executive function, Dr. Jonathan Rasouli, head neurosurgery residing at the Icahn School of Medicine on Mount Sinai in New York City, which was part of the team that treated Palma.
Her lesion was located right next to the brain area that controls speech and it illuminated when MRI was made with contrast, suggesting a malignant brain tumor, Rasouli added. Doctors advised Palma that she was potentially exposed to cancer that required surgery, chemotherapy and radiation.
"My husband and I were both in shock and we just wanted to take care of it." Palma remembered when she heard the diagnosis. "I never really allowed myself to think it was cancerous."
It turned out she was right.
Da Dr. Raj Shrivastava, a neurosurgeon at Mount Sinai Hospital, and Rasouli opened his skull during the operation in the fall, expecting to find a typical brain tumor: soft and scattered.
Instead, they saw "this very firm, very well-encapsulated thing. It looked like a quail egg," recalled Rasouli. They removed it in one piece and cut it to see what was inside.
"It's probably enough that a baby tapeworm came out of that lesion," Rasouli said.
The doctor, with relief on behalf of the patient, told her her prognosis was much better than if they had found a malignant brain tumor: "She had a single parasite in her head that we could take out – we were very happy …. It was one of those rare situations where you see a parasite and you are like, wow, it's great! "
A parasite in the brain sounds like a sudden horror movie, but it is a preventive infection from a swine bandworm called neurocysticercosis – a leading cause of epilepsy to adults, according to the Centers for Disease Control and Prevention .
About 1,000 people admitted to hospital neurocysticercosis in the United States each year with most patients coming from regions where the disease is common, including Latin America, noted the agency. Rasouli described it as "super rare" in the United States
When a patient complains of symptoms and has risk factors for this type of infection, such as living or traveling to those regions or eating raw pigs, the doctors can put the two together and get rid of with the parasite with antibiotics – no surgery required.
But neurocysticercosis was not even on the radar, as doctors rated Palma's lesion because she did not have any of the risk factors. She recalled her reaction when she told her that she had carried a parasite in her brain: "I thought" rough. "I didn't know what to think. I was relieved at the time it wasn't cancerous and I wouldn't need any further treatment," Palma said.
"I don't like to wonder how I got a contract because I don't know."
It happens when people turn off microscopic tapeworm eggs, the CDC explained. The process is not a beautiful picture.
Let's say a food worker eats undercooked pork that has a tape worm inside it, Rasouli said. The ribbon worm develops into an adult inside his colon and begins to throw eggs in his faeces. If the worker goes to the toilet and does not wash his hands well, he will have the eggs on his fingers.
If he then handles food that is raw or not thoroughly cooked, such as lettuce, a person can swallow a tapeworm egg that can travel anywhere in the body and typically end up in the brain, Rasouli said.
"It's so rare in the United States that you really don't have to take any kind of precaution. It's like once in a blue moon," he noted.
As he traveled, he urged people to make sure that all the raw fruits and vegetables they eat are washed very well, especially in countries where neurocysticercosis is endemic like Mexico, he added.
Palma's symptoms have since resolved, and a final brain scan two months ago was completely clear. She has dismissed herself for never knowing how she contracted the infection, she said, focusing instead on the good result. "I'm basically cured," she noted.