Surgeons Expecting To Remove A "Brain Tumor" Instead Found Something They Had Never Seen Before

Mount Sinai Health System

This time last year, Rachel Palma didn’t feel like herself. She had started feeling numbness along the right side of her body, was experiencing episodes of confusion, and was having nightmares despite not having a past medical history that would explain such symptoms. Plus, she was young and otherwise healthy.

The sudden and unexpected neurological symptoms prompted her primary care doctor to order an MRI that led to a more “troubling and distressing” finding: a small lesion in the left frontal part of her brain that, given its location, coordinated with her right-sided symptoms.

“Based on the imaging at the time and her clinical presentation and history, we thought we saw what appeared to be a brain tumor,” Jonathan Rasouli, chief resident of neurosurgery at Mount Sinai Hospital, told IFLScience. “She essentially had no other risk factors for an infectious cause or for malignancy or cancer anywhere else in the body.”

A team of medical experts believed Palma was suffering from a brain tumor and recommended she undergo a small craniotomy that would entail opening the skull directly over the lesion in order to dissect it – all without damaging nearby brain tissue and blood vessels. But when they went in, they came across something they had never encountered before.

A team of medical experts believed Palma was suffering from a brain tumor and recommended she undergo a small craniotomy that would entail opening the skull directly over the lesion in order to dissect it. Mount Sinai Health System

“As we were exposing the lesion, we quickly realized that what we were looking at clearly was not a brain tumor,” said Rasouli. “In fact, it seemed to be more like an egg, which is very strange because you don’t really expect to see something like that in someone’s brain.” Rasouli says he was mystified but worked to remove the “well-encapsulated, firm lesion” in one piece.

“It looked like a quail egg – same size, same texture,” said Rasouli, who added that he then took the lesion aside and dissected it under a surgical microscope. Slithering out of what he thought was a lesion was, in fact, a baby tapeworm.

Palma was suffering from what is known as neurocysticercosis, an inflammation of the brain that occurs when the eggs of Taenia solium (pork tapeworm) are accidentally ingested. It’s the same species that can live in our colon and is common in low-income countries where food safety and sanitation practices may not be as streamlined. But the 42-year-old hadn’t recently traveled outside of the country, leading doctors to believe she may have unintentionally consumed contaminated raw or uncooked pork, meat, or fruits and vegetables.

Slithering out of what he thought was a lesion was, in fact, a baby tapeworm. Mount Sinai Health System

“There are certain states and there are certain countries where this bug is more prevalent. That tends to be the southwestern US, primarily from a large immigrant population of people who are originally from countries where this bug is very prevalent,” explained Rasouli, adding that the primary treatment of T. solium is antibiotics. If Palma had had certain risk factors, then doctors would have opted out of the brain surgery altogether.

If left undiagnosed, Rasouli says the brain's inflammatory response would not have allowed the tapeworm to get past the embryonic stage. A lack of blood supply would have ultimately killed the parasite, becoming scar tissue. 

"But the scar tissue can also create problems, so it's not totally benign to just leave the parasite in the brain and let it go away on its own," said Rasouli. 

The best precaution against potential infection is cooking your meat well, washing your fruits and vegetables, and ensuring that the food you eat comes from a reputable place. And in a case that could have had a much more somber outcome, Rasouli says Palma’s remarkable recovery offers food for thought in future cases.

“Some thoroughly washed and well-handled food for thought," he laughed.

 

[H/T: ABC Inside Edition]

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