Special thanks you to PacuMom for teaching me on the pacu IDs...
We've lost our only pacu that we bought 5 years ago (the rest current 6 are rescues). Final measures - 32 inches long, 12 inches tall (without fins), around 30 pounds.
Strange case. It became paralyzed from pectoral fins down a week ago. Never sick, never sulking. Always on the go and a bottomless pit at feeding times. My strawman hypothesis is that it got poked with a mullet spine inside its mouth or somewhere deeper. The day or two before, the pacu gang stole a piece or two of a 2-foot mullet that was meant for the catfish. They do it sometimes, despite being well fed on their own feed. They proceeded, as usual, to tear it apart like their infamous cousins Serrasalmus piranha. Mullets have sizeable spines in the pectoral, dosal, and anal fins. I don't bother snipping them off when feeding catfish because the cats know how to handle them...
We had a case or two before like that or very reminiscent of that but not with pacu, it was with silver arowana but the arowana became paralyzed or lost the ability to swim and hold themselves upright immediately upon grabbing a piece of spiny fish. It was obvious they got poked badly (I have been snipping the spines off for arowana ever since). These arowana were separated and recovered fully and well though...
In sum, I truly can't think of anything else. Worms in brain / nervous system is too far fetched and I have never seen any symptoms of this before in this or any other pacu (have had a hundred over the last decade). I dissected the pacu. Looked healthy and nice inside. The pacu was chuck full of eggs, probably about 3-5 pounds of eggs. Pacu eggs are grey-greenish-bluish in color and very small in size. So it was a female and about to spawn. Being gravid with eggs places an additional enormous stress on a female fish body, which exacerbates any other problems. So being gravid didn't help for sure.