A case series on neurocysticercosis without seizures in alcohol-dependent patients.

Background: Cysticercosis, caused by the larval form of Taenia solium, is a major public health concern in developing countries, driven by poor sanitation and unsafe food practices. Neurocysticercosis (NCC), the form that affects the central nervous system, is a leading preventable cause of epilepsy worldwide. Seizures are the most common manifestation of NCC, particularly in parenchymal involvement. However, NCC is a pleomorphic disease, and its clinical manifestations depend on the location, number, and stage of cysts as well as host immune responses. Cases: This case series reports three patients with long-term alcohol dependence who developed extensive NCC without experiencing seizures-an unusual presentation. All three patients, aged 28 to 50 years, had a history of chronic alcohol consumption and presented with neuropsychiatric symptoms, including headaches, hallucinations, confusion, and gait disturbances. Neuroimaging revealed widespread cystic lesions consistent with NCC. While seizures are expected in such cases, none of the patients exhibited them. The absence of seizures may relate to alcohol's complex modulation of immune function and neuronal excitability. Conclusion: These cases underscore the importance of detailed neurological evaluation in alcohol-dependent patients, particularly with atypical symptoms. Neuroimaging plays a pivotal role in diagnosing NCC, which can present without its most common hallmark symptom-seizures.