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Year : 1999  |  Volume : 9  |  Issue : 3  |  Page : 151-152
Rapid onset unilateral vision loss by intraocular cysticercosis-demonstrated by MRI


Department of Radiodiagnosis, Raj Scanning Ltd., Lucknow, India

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How to cite this article:
Rao KM, Vargiya SV, Kohli N. Rapid onset unilateral vision loss by intraocular cysticercosis-demonstrated by MRI. Indian J Radiol Imaging 1999;9:151-2

How to cite this URL:
Rao KM, Vargiya SV, Kohli N. Rapid onset unilateral vision loss by intraocular cysticercosis-demonstrated by MRI. Indian J Radiol Imaging [serial online] 1999 [cited 2019 Oct 17];9:151-2. Available from: http://www.ijri.org/text.asp?1999/9/3/151/28325
Sir,

We would like to present a case of intra-ocular cysticercosis with severe ocular inflammation after supplementation of medical therapy, causing loss of vision/eye.

A twenty-five years old, non-vegetarian Hindu man suffering from headache for three months and having had two episodes of focal seizures with secondary generalization came to our center, with a CT report. The CT revealed multiple inflammatory granulomas with different sizes, shapes and levels of reaction. Most of the lesions were in the gray matter area and a few had cystic components. The diagnosis was neurocysticercosis with multiple granulomas in different stages of degeneration. Medical treatment was started with steroids and albendazole. A week later, the patient complained of pain and slight diminution of vision in the right eye. CT and MR of the brain and orbit were then performed. We found two cystic lesions in the posterior wall of the right eyeball with retinal detachment [Figure - 1],[Figure - 2],[Figure - 3]. Albendazole was stopped but steroid therapy was continued.

Despite the withdrawal of albendazole, the vision in the right eye was completely lost within five days. On ophthalmic examination, multiple small hemorrhagic foci were found in the vitreous along with retinal detachment. Severe orbital cellulitis and pain developed. After a detailed ophthalmic and neurological evaluation, enucleation was performed 15 days later. The patient improved rapidly during the post-operative phase. The left eye was normal.

Many parasites can infect the brain and orbits, cysticercosis, toxoplasmosis and Schistosomiasis being the most common. Rarely, amebiasis and Echinococcosis may involve these organs. Intracranial cysticercosis is the most common parasitic cerebral and orbital infestation world wide [1],[2]. Once inside the intestinal tract, the released eggs produce oncospheres, i.e. the primary larvae. These larvae penetrate the intestinal mucosa and enter the circulatory system. Hematogeneous spread to neural, muscular and ocular tissues occurs. Inside the brain and ocular tissue, the oncospheres develop into secondary larvae i.e. the cysticerci [3]. Intra-orbital and intra-ocular cysticerosis however is rare.

When these cysticerci die and degenerate, a severe inflammatory response results in the adjacent tissue which is responsible for various clinical appearances and manifestations. MR is the best tool for demonstrating cysticercosis. Thorough evaluation of the orbits in the presence of multiple intracranial and soft tissue cysticercosis is important in order to rule

out orbital as well as ocular foci before commencing medical management in order to avoid ocular complications. In our patient with intracranial cysticercosis, the focus in the eyeball was missed on the initial CT, leading to the devastating complication of loss of the eye.

 
   References Top

1.Del Brutto OH, Santibanez R. Noboa C.A. et al . Epilepsy due to neurocysticercosis. Analysis of 203 patients, Neurol. 1992; 42: 389-392.   Back to cited text no. 1    
2.Chang KH, Cho SY, Hesselink JR et al . Parasitic disease of the C.N.S. Neuro-imaging Clin. N. Amer. 1989; 1: 159-178.   Back to cited text no. 2    
3.Bowen BC, Post MJD. Intracranial infection. In Atlas S. (ed.). Magnetic Resonance Imaging of the Brain and Spine, pp 501-538. New York: Raven Press 1991.   Back to cited text no. 3    

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Correspondence Address:
Krishna M Rao
Department of Radiodiagnosis, Raj Scanning Ltd., Lucknow
India
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Source of Support: None, Conflict of Interest: None


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[Figure - 1], [Figure - 2], [Figure - 3]

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