What happened, in summary

A woman in her mid-50s was admitted after two weeks of dizziness and weakness in her left arm. She was a smoker but had no recent travel to regions where neurocysticercosis or tuberculosis was common. Neurologic examination showed distal weakness in the left upper limb and brisk reflexes, while sensation and cranial-nerve function remained intact. Brain imaging revealed numerous cystic lesions with an appearance that resembled different stages of neurocysticercosis rather than the more typical pattern of metastatic tumors.

Because the radiologic picture suggested a parasitic infection, clinicians initially started albendazole. She did not improve, and during hospitalization she developed generalized tonic-clonic seizures. Levetiracetam was added for seizure control and dexamethasone for surrounding brain edema. Testing for Taenia solium was negative, so albendazole was stopped. Histologic evaluation then established that the lesions were brain metastases from clear cell lung carcinoma. The cancer was already metastatic at diagnosis, although she had no respiratory complaints.

She received whole-brain radiation therapy, but her neurologic condition continued to worsen. Confusion, dizziness, weakness, disorientation, and visual hallucinations progressed, followed by partial status epilepticus. The malignancy continued to spread, and she died four months after diagnosis. Her course illustrates how an unusual cystic pattern of brain metastases can delay recognition of an underlying lung cancer when the patient has few pulmonary symptoms.