A terrifying diagnosis turned into a scene from a horror movie when a woman’s brain tumor turned out to actually be a parasite.
Yes doc! It was a tapeworm, not a tumor!
Rachel Palma of Middletown, New York, has recovered and been given clear brain scans since the chilling find, but it was just a year and a half ago when that wasn’t the case.
The 42-year-old said she began noticing something wrong in January 2018. In addition to having hallucinations and episodes of confusion, she said she would forget words.
This is when her primary care doctor ordered 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.
The medical team expected a tumor… But it was a tapeworm
“Based on the imaging at the time and her clinical presentation and history, we thought we saw what appeared to be a brain tumor,” said Jonathan Rasouli, chief resident of neurosurgery at Mount Sinai Hospital. “She essentially had no other risk factors for an infectious cause or for malignancy or cancer anywhere else in the body.”
Medical experts recommended she undergo a small craniotomy that would entail opening the skull directly over the lesion in order to dissect it and remove the brain tumor. But when they went in, they came across something they had never encountered before.
“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.
A baby pork tapeworm in New York?
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. 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.
“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.
And what if the worm had lived?
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.
This event shows that even in the US, you can find tapeworms in your meat, fruits and vegetables. So you better cook your meat well, carefully wash your fruits and vegetables, and make sure that the food you eat comes from a reputable place. Stay safe!