Neurocysticercosis (NCC) is a CNS infection with variable presentations based on cyst factors. Racemose NCC is an aggressive form of extraparenchymal NCC with high morbidity/mortality. We report a case of racemose NCC presenting with seizures in a 17-year-old male nonpork consumer. Emergency assessment enabled diagnosis via imaging/labs, identifying this rare form despite the absence of NCC risk factors. Management was initiated, with anthelmintics and monitoring leading to recovery. This case demonstrates NCC's spectrum even in unusual hosts, highlighting the need for wide diagnostics based on clinical findings when NCC likelihood is high regardless of the typical risk profile due to exposure knowledge gaps. Despite atypical features, emergency evaluation of this patient's symptoms facilitated appropriate diagnosis and life-saving racemose NCC-directed therapy. It underscores NCC's variable manifestations and reinforces employing a broad differential and individualised care based on clinical presentation rather than stereotyped expectations.
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