Elsevier

Ophthalmology

Volume 106, Issue 12, 1 December 1999, Pages 2336-2340
Ophthalmology

Myocysticercosis: Experience with imaging and therapy1,

Presented in part as a poster at the American Academy of Ophthalmology annual meeting, San Francisco, California, October 1997.
https://doi.org/10.1016/S0161-6420(99)90537-7Get rights and content

Abstract

Objective

To compare computed tomography (CT) and B-scan ultrasonography (USG) in the diagnosis and to study the efficacy of a combination of oral albendazole and prednisolone in the management of myocysticercosis.

Design

Retrospective, noncomparative case series.

Participants

Twenty-six consecutive patients with myocysticercosis.

Intervention

Diagnostic imaging was performed by CT scan and USG in 24 and 22 patients, respectively; serial USG was obtained in 7 patients receiving treatment. All patients received oral albendazole (15 mg/kg body weight per day) and prednisolone (1.5 mg/kg body weight per day) for 4 weeks.

Main outcome measures

Presence of scolex on CT scan compared to USG and clinical response to medical therapy were the main outcome measures. Recovery was defined as complete resolution of the scolex or of the main presenting clinical feature.

Results

Presence of scolex on CT scan (11 of 24) and USG (11 of 22) was not different (P = 1.0; chi-square test). Recovery was seen in 24 (92%) of 26 patients receiving medical treatment. On serial USG of patients receiving treatment (n = 7), cysts with scolex were seen to progress to a cyst without scolex before final resolution. Time to recovery on treatment (0.5–35 months) correlated with the duration of symptoms at presentation (correlation coefficient r = 0.56, P = 0.003, linear regression analysis), but not with positive serum enzyme-linked immunosorbent assay for anticysticercal antibodies (P = 0.57, log-rank test) or the presence of scolex (P = 0.52, log-rank test).

Conclusions

Treatment with a combination of oral albendazole and prednisolone is effective in the management of myocysticercosis. Imaging methods CT and USG are equally effective in identifying the cyst and the scolex; serial USG is useful in studying the temporal sequence of therapeutic response. The longer recovery time correlating with the duration of symptoms may indicate the chronicity of the inflammatory changes requiring longer time for recovery.

Section snippets

Patients and methods

A retrospective chart analysis was performed on 26 consecutive patients with myocysticercosis. Myocysticercosis was diagnosed when (1) the patient presented with one or more of the following clinical features: proptosis, restriction of ocular motility, acquired ptosis, or signs and symptoms of orbital inflammation and (2) CT scan or USG or both revealed a cystic lesion with or without scolex within or attached to an extraocular muscle. Visible scolex within the cyst was taken as diagnostic of

Results

Twenty-six consecutive patients with myocysticercosis were evaluated. The age of the patients ranged from 6 to 32 years with a mean of 14.8 years. There were 10 male and 16 female patients. All the 26 patients had a cyst associated with a single extraocular muscle. Inferior rectus was most commonly involved (8 of 26, 31%), followed by superior rectus (6 of 26, 23%), levator palpebrae superioris (4 of 26, 15%), medial rectus (3 of 26, 11%), lateral rectus (2 of 26, 8%), superior oblique (2 of

Discussion

Orbital cysticercosis in this series presented with variable clinical features including inflammatory proptosis, restricted ocular motility, and ptosis. Identification of the scolex within the cyst on imaging is diagnostic of cysticercosis.1, 2 There are a number of other causes of cystic lesions within the extraocular muscles.1 In earlier publications, we have presented the possibility of these cystic lesions without a scolex being idiopathic orbital myositis.1, 2 Natural history of the

References (11)

There are more references available in the full text version of this article.

Cited by (48)

  • Cysticercosis in ophthalmology

    2022, Survey of Ophthalmology
    Citation Excerpt :

    It was noted that the scolex disappeared at 2–3 weeks, and the cyst started shrinking and it collapsed signific around 4–8 weeks after the initiation of treatment.171 Thereafter, the normal thickness muscle was seen on imaging .161 Similarly, Ganesh and coworkers reported favorable results with medical treatment in more than 90% patients of extraocular cysticercosis by 2 months.47

  • Neurocysticercosis. A frequent cause of seizures, epilepsy, and other neurological morbidity in most of the world

    2021, Journal of the Neurological Sciences
    Citation Excerpt :

    Ag-ELISA is less sensitive than the LLGP-EITB, but its advantages relate to demonstrating live parasite infections (test results are negative in cases with resolved cysticercosis) and its rapid decay after effective treatment, allowing its use to monitor therapy results. While serology has a complementary role in NCC, a positive antibody or antigen test without diagnostic imaging should not be interpreted as NCC as myocysticercosis or ocular cysticercosis could be positive without NCC [52,53]. So far, PCR tests for NCC are restricted to exploratory reports in CSF of extraparenchymal NCC without convincing data on their performance for intraparenchymal NCC where most diagnostic doubts arise [54–57].

  • Myositis, Pyomyositis, and Necrotizing Fasciitis

    2018, Principles and Practice of Pediatric Infectious Diseases
  • Ocular parasitoses: A comprehensive review

    2017, Survey of Ophthalmology
  • Retroorbital optic nerve cysticercosis

    2016, American Journal of Emergency Medicine
  • Intraorbital Cystic Lesions: An Imaging Spectrum

    2015, Current Problems in Diagnostic Radiology
    Citation Excerpt :

    The cysts are most commonly seen in the subcutaneous tissues, muscles, brain, and eyes. Extraocular muscles are the most commonly affected site in the orbit26; the eyelid, retro-orbital space, and lacrimal gland are other locations where the parasite may lodge.27 Subretinal space is the most common location within the globe; the vitreous body and even optic nerve may be affected once it enters the choroidal circulation.28

View all citing articles on Scopus

Supported by Hyderabad Eye Research Foundation, Hyderabad, India.

1

The authors do not have any commercial interest in any of the materials and methods used in this study.

View full text