Snapshot A patient presents with a fever and a headache and is "not acting right," according to the patient's daughter. On physical exam the patient has unsteady gait, and weakness of his left arm. The patient is started on antibiotics and a CT of the head is obtained. Introduction Risk factors include congenital R to L shunt (bypass lung filtration) otitis paranasal sinusitis metastases trauma immunosuppression Causes include: anaerobes aerobes gram-positive cocci gram-negative rods helminthic infections Helminthic Infections Helminth Presentation Transmission Treatment Cysticercosis (Taenia solium) Encephalitis in Latin American immigrant in neurocysticercosis until proven otherwise Eggs transmitted by fecal oral route Praziquantel Albendazole Steroids Hydatid cysts (Echinococcus) Presents with focal symptoms and seizures. Fatal anaphylaxis if cysts rupture Acquired by dog feces Mebendazole Careful surgical evacuation Presentation Symptoms headache fever Physical exam increased ICP focal neurological findings Management Perform a head CT to assess abscess perform a biopsy and give antibiotics update antibiotic coverage based on microbiology results Surgical drainage if > 3 cm or if persists Prognosis, Prevention, and Complications Invariably fatal if not treated Suspect T. gondii in a patient with HIV with T-cells less than 100