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BMJ Case Reports 2018; doi:10.1136/bcr-2018-227869
  • Images in…

Neurocysticercosis: do not miss the eye

  1. Asim Ghosh1
  1. 1Medical College and Hospital, Kolkata, West Bengal, India
  2. 2Post Graduate Institute of Medical Education and Research, Chandigarh, India
  1. Correspondence to Deepanjan Bhattacharya, b.deepanjan{at}yahoo.co.in
  • Accepted 19 October 2018
  • Published 3 November 2018

Description 

A 6-year-old girl presented with new-onset left focal seizures, and was started on valproate. There was no history of fever, headache, visual deficit and neurological examination was completely normal. Neuroimaging revealed ring enhancing lesion in the right parietal lobe. Ocular examination revealed visual acuity of 6/6 in both eyes, with no evidence of uveitis or other abnormality of the anterior segment. Fundus examination revealed hypopigmented area in left retina midway between fovea and optic disc. Optical coherence tomography (OCT) using Spectralis HRA-OCT revealed presence of scolex beneath the retinal pigment epithelium (figure 1A). A Child was started on oral prednisolone and albendazole, and a 28-day course was completed. Repeat OCT revealed resolution of the scolex (figure 1B) and neuroimaging showed disappearance of the ring-enhancing lesion.

Figure 1

(A) Optical coherence tomography showing scolex beneath the retinal pigment epithelium (B) Optical coherence tomography showing resolution of scolex after completion of therapy.

Cysticercosis is quite a common disease in tropical countries and is often difficult to diagnose. Demonstration of cysticercus by histology or subretinal parasite by funduscopy form absolute criteria for diagnosis of cysticercosis.1 Chavala et al reported a 25-year-old pork handler with intraretinal cysticercosis associated with vision loss, and ocular ultrasound revealing retinal detachment with hypoechoic focus, which responded to antihelmintic therapy.2 However, in the index case, there was no visual impairment, and response to therapy was excellent. OCT in suspected cases may be helpful in early detection as well as giving high-resolution images.

Learning points

  • Ocular examination is of paramount importance in neurocysticercosis.

  • Optical coherence tomography can diagnose lesions better with better resolution.

Footnotes

  • Contributors DB: patient management, literature review and preparation of the initial draft of the manuscript. AG: clinician-in-charge, critical review of the manuscript for important intellectual content and final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

References

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