CASE REPORT Lung cancer: atypical brain metastases mimicking neurocysticercosis Patrı ´cia Caetano Mota • Carina Reis • Nuno Filipe Pires • Grac ¸a Sousa • Clara Chamadoira • Marcos Guimara ˜es • Lı ´gia Castro • Margarida Marques • Isabel Gomes Received: 21 November 2010 / Accepted: 23 February 2011 / Published online: 25 March 2011 Ó Japan Society of Clinical Oncology 2011 Abstract The authors describe a case of a 47-year-old male smoker with a 3-month history of hearing loss, tin- nitus and dizziness. Physical examination revealed neuro- sensory hearing loss. Small rounded hypodensities without mass effect were evident in a computed tomography scan of the head, confirmed by brain magnetic resonance imaging as multiple cystic lesions in both cerebral and cerebellar hemispheres, without perilesional edema or gadolinium enhancement, suggestive of neurocysticercosis. Extraparenchymal involvement was also noted. Albenda- zole and dexamethasone were started. As a chest radio- graph showed a bilateral reticulonodular pattern, a bronchoscopy was performed showing normal results. However, transbronchial biopsy revealed lung adenocar- cinoma. Thoracoabdominopelvic computed tomography scan showed secondary lung and bone lesions. Since brain lesions were not suggestive of secondary tumor lesions, a brain biopsy was performed confirming metastatic disease. This case illustrates some peculiar imagiological features of brain metastases in lung cancer, indicating that some- times invasive procedures are required to establish a definitive diagnosis. Keywords Lung cancer Á Brain metastases Á Neurocysticercosis Introduction Lung cancer is the most common primary solid tumor responsible for brain metastases; the malignancy can ini- tially present with a wide spectrum of clinical manifesta- tions [1]. Multiple brain metastases are frequent and can assume peculiar radiographic features suggestive of other central nervous system lesions (primary tumors or vascular, inflammatory or infectious diseases) [1]. Case report A 47-year-old male heavy smoker, previously healthy, was admitted to hospital with a 3-month evolution of bilateral hearing loss, associated with tinnitus, dizziness and imbalance. No regular medication was reported. He used to consume smoked pork meat. On physical examination, he appeared in good health with normal vital signs. He had no rash or adenopathy. Cardiac, pulmonary and abdominal findings were normal. P. C. Mota (&) Á N. F. Pires Á I. Gomes Department of Pulmonology, Hospital de Sa ˜o Joa ˜o, Alameda Professor Herna ˆni Monteiro, 4200-319 Porto, Portugal e-mail: patmota@net.sapo.pt C. Reis Department of Neuroradiology, Hospital de Sa ˜o Joa ˜o, Alameda Professor Herna ˆni Monteiro, 4200-319 Porto, Portugal G. Sousa Department of Neurology, Hospital de Sa ˜o Joa ˜o, Alameda Professor Herna ˆni Monteiro, 4200-319 Porto, Portugal C. Chamadoira Department of Neurosurgery, Hospital de Sa ˜o Joa ˜o, Alameda Professor Herna ˆni Monteiro, 4200-319 Porto, Portugal M. Guimara ˜es Á L. Castro Department of Pathology, Hospital de Sa ˜o Joa ˜o, Alameda Professor Herna ˆni Monteiro, 4200-319 Porto, Portugal M. Marques Department of Radiotherapy, Hospital de Sa ˜o Joa ˜o, Alameda Professor Herna ˆni Monteiro, 4200-319 Porto, Portugal 123 Int J Clin Oncol (2011) 16:746–750 DOI 10.1007/s10147-011-0221-7