Rachel Palma’s symptoms were strange and disturbing: She was having hallucinations, insomnia and “horrific nightmares.” Her right hand would suddenly give way and she’d drop things. She was having trouble finding the right words and made alarming phone calls to her family that she didn’t remember.
“My episodes were getting more and more bizarre,” Palma, 42, who lives in Middletown, New York, told TODAY. “There were days that I didn’t know where I was.”
She’d been to urgent care several times after the trouble began early last year, but the cause remained a mystery. Finally, an MRI scan of her head caught doctors’ attention: It showed a lesion on the left side of her brain roughly the size of a marble.
The left side of the brain in right-handed people controls language and executive function, said Dr. Jonathan Rasouli, chief neurosurgery resident at the Icahn School of Medicine at Mount Sinai in New York City, who was part of the team that treated Palma.
Her lesion was located right next to the area of the brain that controls speech and it lit up brightly when the MRI was done with contrast, suggesting a malignant brain tumor, Rasouli added. Doctors counseled Palma that she was potentially facing a cancer that required surgery, chemotherapy and radiation.
“My husband and I were both in shock and we just wanted it taken care of,” Palma recalled when she heard the diagnosis. “I never really allowed myself to think that it was cancer.”
It turned out she was right.
When Dr. Raj Shrivastava, a neurosurgeon at Mount Sinai Hospital, and Rasouli opened her skull during surgery last fall, they expected to find a typical brain tumor: soft and spread out.
Instead, they saw “this very firm, very well encapsulated thing. It looked like a quail egg,” Rasouli recalled. They removed it in one piece and cut into it to see what was inside.
“Sure enough, a baby tapeworm came out of that lesion,” Rasouli said.
The medical team cheered with relief on behalf of the patient, knowing her prognosis was now much better than if they’d found a malignant brain tumor: “She had a single parasite in her head that we were able to take out — we were very happy.... It was one of those rare situations where you see a parasite and you’re like, wow this is great!”
A parasite in the brain sounds like the plot of a horror movie, but it’s a preventable infection from a pork tapeworm known as neurocysticercosis — a leading cause of adult onset epilepsy worldwide, according to the Centers for Disease Control and Prevention.
About 1,000 people are hospitalized for neurocysticercosis in the U.S. each year, with most patients coming from regions where the disease is common, including Latin America, the agency noted. Rasouli described it as “super rare” in the U.S.
When a patient complains of symptoms and has risk factors for this type of infection, such as living in or traveling to those regions or eating raw pork, doctors can put the two together and get rid of the parasite with antibiotics — no surgery required.
But neurocysticercosis wasn’t even on the radar when doctors evaluated Palma’s lesion because she had none of the risk factors. She recalled her reaction when told she’d been carrying a parasite in her brain:
“I thought ‘gross.’ I didn’t know what to think. I was relieved at that point that it wasn’t cancer and that I wouldn’t need any further treatment,” Palma said.
“I don’t like to speculate how I may have contracted it because I don’t know.”
It happens when people swallow microscopic tapeworm eggs, the CDC explained. The process is not a pretty picture.
Let’s say a food service worker eats undercooked pork that has a tapeworm inside of it, Rasouli said. That tapeworm develops into an adult inside his colon and starts shedding eggs inside his feces. If that worker goes to the bathroom and doesn’t wash his hands well, he will have the eggs on his fingers.
If he then handles food that’s raw or not thoroughly cooked, like salad, a person can swallow a tapeworm egg, which can travel anywhere in the body and typically ends up in the brain, Rasouli said.
“It’s so rare in the United States that you really don’t have to take any sort of precautions. It’s like once in a blue moon,” he noted.
When traveling, he urged people to make sure any raw fruits and vegetables they eat are washed very well, especially in countries where neurocysticercosis is endemic, like Mexico, he added.
Palma’s symptoms have since all resolved and a final brain scan two months ago was all clear. She has resigned herself to never knowing how she contracted the infection, she said, focusing instead on the good outcome. “I’m basically cured,” she noted.