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June 10, 2019

Surgeons went in to remove a brain tumor—but they found a tapeworm instead

Daily Briefing

    Editor's note: This popular story from the Daily Briefing's archives was republished on Jan. 6, 2021.

    Doctors at Mount Sinai Hospital believed Rachel Palma had a cancerous tumor in her brain, but when surgeons went in to remove it, they instead found a tapeworm, Lindsey Bever writes for the Washington Post.

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    Strange symptoms

    Palma, a 42-year-old woman from Middletown, New York, told Bever she'd been experiencing a variety of symptoms for a long time. She had hallucinations and dealt with insomnia, and when she could sleep, she had nightmares.

    But in January 2018, her symptoms got worse. Palma said she had difficulty holding things and texting people. She also started getting confused easily, locking herself out of her house or showing up to work without her uniform on. At one point, she said she called her parents and told them that the store she purchased her bed at years ago had decided it wanted the bed back.

    Finding the tapeworm

    After a series of doctor's appointments and visits to the ED, Palma saw specialists at Mount Sinai who discovered a "lesion on her left frontal lobe, near a speech center," Bever writes. Jonathan Rasouli, chief neurosurgery resident at the Icahn School of Medicine at Mount Sinai, said the lesion's shape on the MRI looked like a brain tumor.

    In September 2018, Rasouli and other surgeons went in to remove the suspected tumor from Palma's brain. But when they opened Palma's cranium, they instead saw an encapsulated mass that resembled a quail egg, Bever writes.

    "We were all saying, 'What is this?'" Rasouli said. "It was very shocking. We were scratching our heads, surprised at what it looked like."

    The surgeons removed the mass from Palma's brain and cut into it, and found a baby tapeworm inside, Bever writes. Doctors ultimately diagnosed Palma with neurocysticercosis, a parasitic brain infection caused by the tapeworm known as Taenia solium.

    Palma said she was "grossed out," but also "relieved" by the diagnosis, because it meant "that no further treatment was necessary." Palma said her symptoms have "almost 100%" gone away. "The best part of my story is it has a happy ending," she said.

    How does a tapeworm end up in your brain?

    Bobbi Pritt, director of the Clinical Parasitology Laboratory in the Mayo Clinic's Department of Laboratory Medicine and Pathology, said Taenia solium is uncommon in the United States. But he explained it can occur when individuals ingest an adult tapeworm that was lurking in undercooked pork and then lives in the individual's gut. In addition, people who have the adult form of the tapeworm can pass on its eggs if they don't wash their hands properly, Pritt said.

    For example, if someone with the adult tapeworm gets the eggs on their hands and then prepares food for another individual, the other person could unknowingly eat the eggs, Pritt said. Then, those eggs would travel to the small intestine and hatch into larvae, which could then penetrate the bowel wall and travel through the bloodstream anywhere in the body, including the brain, Pritt explained.

    According to Pritt, the adult form of the tapeworm is treated with antiparasitic medication, but treating larvae can be more complex, and the type of treatment depends on the larvae's location and the stage of infection.

    However, cases such as Palma's are rare, Bever writes. "I want people to understand that this was such a rare occurrence," Palma said. "Every headache is not going to be a parasite" (Bever, Washington Post, 6/6).

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