Preeclampsia is a common diagnosis during pregnancy. The symptoms of neurocysticercosis are similar to preeclampsia. A misdiagnosis can be deadly for the mother and fetus. It is important for healthcare providers to recognize the subtle differences and provide appropriate treatment.
A 30-year-old gravida 1 at 22-weeks gestation was admitted to the hospital for increasing nausea and vomiting for the past 2 weeks. She had a four pound weight loss since the beginning of her pregnancy. She stated she had a mild headache and occasional white spots in vision. She had no other complaints. Her vital signs on admission were temperature 98.1, blood pressure 111/61, pulse 71, respirations 16, and fetal heart rate 140. Her physical exam was normal, and multiple laboratory tests were ordered to rule out causes for hyperemesis.
Her laboratory values came back inclusive for causes for hyperemesis or preeclampsia. Her headaches and vision changes continued to progress along with her nausea and vomiting. The perinatology team ordered a computed tomography scan to assist in determining the cause for her symptoms. The computed tomography showed moderate hydrocephalus. The perinatology team consulted with the neurologist. The neurologic exam found her pupils to be large but reactive. Her speech was clear and she moved all four extremities equally. The neurologist ordered magnetic resonance imaging to assist in determining the cause for the hydrocephalus. The result of the magnetic resonance imaging was a cystic mass consistent with neurocystercosis.
This diagnosis brought a multidisciplinary team of perinatologists, neurosurgeon, neurologists, infectious disease physician, and nursing together to determine the best plan of care for this patient. The patient was transferred to the neurologic intensive care unit for closer monitoring with daily assessment of her fetus by the obstetric nurses. After much collaboration, the patient was treated to decrease the pressure of the hydrocephalus and kill the parasite. The patient was transferred out of the intensive care unit and eventually home. Due to the patient's psychosocial needs, case management was involved in assisting her transition to discharge. The medications were costly and she needed assistance to follow care.
Nursing was integral throughout this process. The patient was concerned for her pregnancy. The obstetric nurses were able to focus on the needs of her pregnancy and the neurologic nurses were able to focus on her medical and neurologic needs.