Neurocysticercosis mimicking eclampsia in a pregnant woman with a history of preeclampsia: a case report.

INTRODUCTION: Eclampsia is the default suspected diagnosis in cases of seizures during pregnancy; atypical or treatment-resistant cases warrant consideration of differential diagnoses for neurological causes. In endemic Andean regions, neurocysticercosis, a brain infection caused by Taenia solium larvae, is one of the leading causes of acquired epilepsy. This case demonstrates how this parasitic infection can mimic a severe obstetric emergency. CASE PRESENTATION: This case describes a 35-year-old mestiza woman at 26.1 weeks of gestation with a history of preeclampsia in two previous pregnancies. She presented to the emergency department with headache, epigastric pain, blurred vision, and normal vital signs, followed by several tonic-clonic seizures. Given this presentation, the medical team immediately suspected eclampsia and initiated the magnesium sulfate protocol, as its mechanism of action promotes cerebral vasodilation and reduces vasospasm, thereby favoring neuroprotection. Laboratory tests showed a urine protein/creatinine ratio of 0.58, with no abnormalities in hepatic or renal function parameters, and no recorded hypertensive values. Despite anticonvulsant administration, the seizures were not controlled, prompting neuroimaging studies. These studies revealed multiple cysts with scolices in the brain, confirming neurocysticercosis in the vesicular stage. Through a multidisciplinary approach, seizures were controlled with levetiracetam, allowing the pregnancy to reach term at 37.5 weeks. The patient had an uncomplicated normal vaginal delivery. In the postpartum period, she successfully started antiparasitic treatment with albendazole and dexamethasone. CONCLUSIONS: This case offers a valuable lesson on the diagnostic challenge posed by the overlapping neurological symptoms of eclampsia and neurocysticercosis. If a pregnant woman presents with atypical seizures or fails to respond to magnesium sulfate, neuroimaging is essential: it is a vital tool for ruling out structural abnormalities and ensuring the wellbeing of both mother and baby.