An ethical dilemma . . .

A 55 year old gentleman had come to us with seizures and hemiplegia about a month back. The arrival of this guy into emergency department was quite dramatic. He was quite a huge guy and he was throwing up multiple episodes of seizures. However, his seizures responded well to routine anti-seizure medications and a CT Scan of the brain showed multiple lesions suggestive of neurocysticercosis with perilesional inflammation. 

He was put on Albendazole, steroids and anti-seizure medication. 

Last week he came for review. As I talked with him, I inquired quite casually if he rode any vehicles. I expected him to say that he did not ride any. 

Instead he asked me why I asked him that question. I told him that while he is on the medications, he cannot drive any vehicles.

He started to sob. He told me that he had been a driver all his life. That was the only job he knew. He had been having seizures since the last 10 years and was thrown out the job from many places as he developed seizures in the middle of his driving. 

It seems nobody told him that it could be healed, although he would have needed to retrain for another job. In fact, when he came to us first time last month, his family had bluffed to us that it was the first time he got seizures. 

Yes . . . a life time of seizures . . . no proper treatment, investigations . . . 

Once his sobbing stopped, I asked him on what he did now for a living . . . I was shell shocked by the answer. 

He was a school bus driver. He reasoned that being a school bus driver, his working hours are much lesser. And therefore, the chance of getting a seizure was low. He was of the opinion that the history of long standing seizures was because of long working hours as a driver . . . That was what many of the quacks whom he consulted for his seizures told him.

I tried to reason with him that being a patient with history of seizures on regular medication, and that too with multiple neurocysticerosis lesions in brain, it would be a hazard for a whole lot of people including school children. 

He started to weep. He told me that it was with much difficulty that he got this job. He and his wife did not have any support from their daughters, who were all married off in far away places. His job was the only source of income . . . 

I knew it was not easy . . . 

Now, what do I do? Give it to him in writing that he cannot drive. Call the school for which he worked and tell them that it was dangerous to have this guy as a driver for their school bus . . . Tell him, that I could recommend him for a job . . . but then, he only knew to drive . . . 

Worm causing seizures . . .

Last week, we had a 7 year old boy coming into emergency with sudden onset seizures. There was no fever. We were almost sure about what we were dealing with. 

Taperworm cyst inside the brain .. .. .. 

Something which we see quite commonly. 

Another tropical condition which is quite neglected. I don't know about data. But here at NJH, we've quite a lot of patients on anti-seizure medication after the cysts were found inside their brain. Including staff and their relatives . . . 

The traditional and commonly held knowledge is that the infestation is seen in people who eat partially cooked pork. But, what we have in this part of the country is that quite a lot of the patients with neurocysticercosis are vegetarians. 

Of course, we all know the cause. 

The following chart gives the reason . . . 

 

And what could be the major source. This is what I believe is the major culprit.

Yes . . . Salads . . . 

Purported to be very healthy, salads are a major presence in almost diets . . . In addition, the practice of eating raw vegetables. 

Raw vegetables are of course very good from a health point of view. But if they are not washed properly, they could be harbouring eggs of the tapeworm. 

Below is the boy's CT Scan . . . shows the ring shaped lesion. 

So, the next time, you delve into salads, be sure that the vegetables are thoroughly washed.