Note: Names and certain details in this story have been modified to protect patient privacy.

The call came in as a routine trauma alert. A car had veered off the road and struck a tree just outside town. The driver, a 37-year-old man, wasn't wearing a seat belt. Firefighters needed extra time to extract him. When he arrived at the emergency department, he smelled strongly of alcohol, spoke only Spanish, and seemed confused about where he was or how he'd gotten there.

Samuel Edusa, MD. "An AI Generated Sketch of a Car Crash Scene." 2025, Digital artwork generated using Google Gemini. Personal collection.

At first glance, his injuries seemed modest. He complained mostly of soreness along his ribs and shoulder. His vital signs were stable. X-rays and scans of his chest and abdomen showed no broken bones, no bleeding, no collapsed lung. For a crash that looked dramatic at the scene, his body had escaped the worst of it.

But there were details that didn't quite fit.

The Clues That Didn't Belong

While we waited for his blood alcohol level to drop, we spoke with his daughter and a roommate who had been in the car that night. The roommate mentioned something unrelated to the crash itself. About a month earlier, he'd seen the man stiffen, shake violently, and foam at the mouth. The episode lasted several minutes. When it ended, the man was exhausted and confused. There had been another similar episode months before that. He'd never gone to the hospital.

When the patient was more alert, he acknowledged the spells. He said he could sometimes feel them coming. A strange sensation in his body, followed by darkness. Over the past few months, he'd also been dealing with persistent headaches and brief episodes of double vision, which he'd learned to ignore.

Because of the crash, we'd already done a CT scan of his head to rule out bleeding or swelling from trauma. Instead, it revealed something unexpected: multiple small, round spots scattered throughout his brain, some hardened with calcium, others appearing cyst-like. The pattern didn't look like bruising from an accident. It looked older, as if it had been there long before the car left the road.

Samuel Edusa, MD. "Patient CT Scan Showing Multiple Small Lesions Scattered Throughout the Brain." 2025, Actual patient imaging.

We called neurology. An MRI followed. The images showed numerous tiny lesions, each with a characteristic ring and dot, spread across the frontal and parietal lobes, with even one tucked into a ventricle. There was no single mass to blame, no obvious tumor, no stroke. Instead, it looked like a constellation of small invaders, frozen at different stages of life.

Samuel Edusa, MD. "Patient CT Scan Showing Multiple Small Lesions Scattered Throughout the Brain." 2025, Actual patient imaging.

The man's story complicated things. He'd grown up in rural Mexico and had lived in the United States for only a few years. He worked, drove, sent money home. He didn't recall eating undercooked meat. He denied contact with farm animals. His blood tests showed no dramatic signs of infection. His eyes, carefully examined by an ophthalmologist, were clear. No parasites lurking where treatment could cost him his vision.

In the hospital, he didn't have another seizure. Anti-seizure medication steadied him. We started steroids cautiously, not as treatment themselves but to prepare his brain for what might come next. An infectious disease specialist weighed in. A neurosurgeon reviewed the scans and agreed there was nothing to operate on. The danger, he explained, wasn't pressure or bleeding. It was inflammation, what could happen if the immune system suddenly recognized what had been hiding in his brain all along.

A Diagnosis That Explained Everything

Only after days of imaging, consultations, and careful conversations did the pieces come together. The seizures, the headaches, the strange spots on the scans, and even, perhaps, the crash itself all traced back to a single cause. The man was living with a parasitic infection of the brain, acquired years earlier and only now making itself impossible to ignore.

It was a diagnosis rarely seen by many physicians, yet one of the most common causes of adult-onset seizures worldwide: neurocysticercosis. A disease that can lie silent for years before announcing itself, abruptly, in the middle of an ordinary life.

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This case is part of a collection of cases I have seen during my internal medicine rotation, written in the style of The New York Times Diagnosis column, which I subscribe to and enjoy reading.