The headaches had become so splitting for Gerardo Moctezuma that the pain caused him to vomit violently. The drowsiness that came with it had intensified for months. But it wasn't until Moctezuma, 40, fainted without explanation at a soccer match in Central Texas last year that he decided to figure out what was going on.
When Jordan Amadio looked down at his MRI results, the neurosurgeon recognised - but almost couldn't believe - what looked to be lodged in Moctezuma's brain. As he opened up Moctezuma's skull during an emergency surgery in May 2019, he was able to confirm what had set up shop uncomfortably next to the man's brain stem: a tapeworm measuring about 1 1/2 inches.
"It's very intense, very strong, because it made me sweat too, sweat from the pain," Moctezuma said to KXAN.
The clear and white parasite came from tapeworm larva that Amadio believes Moctezuma, who moved from Mexico to the U.S. 14 years before his diagnosis, might have had in his brain for more than a decade undetected. His neurological symptoms had intensified due to his neurocysticercosis, which was the direct result of the tapeworm living in his brain. The cyst would trigger hydrocephalus, an accumulation of cerebrospinal fluid that increased pressure to the skull to the point that the blockage and pain had become life-threatening.
"It's a remarkable case where a patient came in and, if he had not been treated urgently, he would have died from tremendous pressure in the brain," Amadio, attending neurosurgeon at the Ascension Seton Brain and Spine Institute in Austin, told The Washington Post on Thursday night.
The hospital recently revealed Moctezuma's diagnosis, surgery and recovery, described as "rare and truly extraordinary," eight months after the procedure. Amadio said his patient's return to a normal life allowed them to publicly talk about the unusual case.
It remains unclear how Moctezuma ended up hosting a parasite near his brain stem, an area Amadio compared to "very high-priced real estate." Moctezuma believes that it might have come from eating undercooked pork when he was still living in Mexico, CBS Austin reported. Given that pigs often act as intermediary hosts for tapeworms, consuming undercooked pork is perhaps the most common way to transmit a parasite.
But Amadio, 36, said he thinks it was a case of poor hygiene while in Mexico. A more likely scenario for how the tapeworm ended up in his patient, the neurosurgeon said, is that someone else, not Moctezuma, ate undercooked pork around him during his time in Mexico. From there, he said, the infected tapeworm from that person transmitted a microscopic egg through their own stool to the man in a case of fecal-oral contamination, a typical form of infection.
The patient's family has experienced parasites before: Moctezuma's sister reportedly discovered she had a tapeworm in her brain years before her brother's diagnosis.
Amadio recognized that accidentally eating a microscopic egg from the tapeworm larva can go unnoticed and not cause symptoms until they get severe.
"It's certainly possible that he was infected while living in Mexico and the tapeworm was incubating in his system for many years," Amadio said.
The three-hour surgery to remove the tapeworm at Dell Seton Medical Center at the University of Texas proved complex. In opening the skull behind where the brain stem is located, Amadio had to navigate around one of the most treacherous areas of the brain, near a section of essential nerves and blood vessels. Once the tapeworm was removed, Amadio said, the parasite, which could have been spread out in small and numerous larva, was contained to a giant but single cyst.
Amadio stressed that while Moctezuma's situation is rare, similar neurocysticercosis cases occur in the U.S. around 1,000 times each year, according to the Centers for Disease Control and Prevention. Parasites like these are more likely to show up in Texas and California where there are more people emigrating from Mexico or Latin America, Amadio said.
Eight months following the procedure, the neurosurgeon called it a privilege to be able to get to know Moctezuma and see him thrive after a harrowing experience that nearly cost him his life.
"This was an unusual case because it required an emergency surgery," Amadio recalled. "Thankfully, once the lesion was removed, the patient had a spectacular outcome and is happy and living with his family and back to work."