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Year : 2005  |  Volume : 15  |  Issue : 3  |  Page : 309-310
MRI in intraocular cysticercosis - A case report


From the Nijjar Scan & Diagnostic Centre, Amritsar, India

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Keywords: Cysticercosis, Intraocular, MRI

How to cite this article:
Nijjar I, Singh J P, Arora V, Abrol R, Sandhu P S, Chopra R, Roopa. MRI in intraocular cysticercosis - A case report. Indian J Radiol Imaging 2005;15:309-10

How to cite this URL:
Nijjar I, Singh J P, Arora V, Abrol R, Sandhu P S, Chopra R, Roopa. MRI in intraocular cysticercosis - A case report. Indian J Radiol Imaging [serial online] 2005 [cited 2020 Nov 25];15:309-10. Available from: https://www.ijri.org/text.asp?2005/15/3/309/29142
Infection with member of the Taenia tapeworm genus represents an important etiology of parasitic ocular disease. Taenia solium (along with its larval form, cysticercosis cellulosae) is the most-common species causing cysticercosis in humans.

Taxonomically, taeniasis (infection by the adult worm) must be differentiated from the cysticercosis (infection by the larvae). However, patients may harbor both taeniasis and cysticercosis. Taeniasis is an intestinal infection caused by consumption of the adult worm through undercooked pork and is not associated with ocular disease. In cysticercosis, the humans act as an intermediate host following the consumption of eggs in contaminated food or water. After ingestion, the eggs hatch and mature to larvae, which are carried by mesenteric vessels to various parts of the body, where they are filtered through subcutaneous and intramuscular tissues, with preference for the brain and eyes [1]. Ocular disease is reported to occur in a significant number of cases of cysticercosis [2].

We would like to report a case of a solitary intraocular cysticercosis diagnosed on MRI.

There was no evidence of neurocysticercosis.


   Case report Top


A twenty six year old man presenting with blurring of vision in the right eye for ten days was referred for MRI of the brain by a general practitioner. There was no history of trauma, hypertension, diabetes or neurological deficit.

Routine MRI of the brain on 1.5 Tesla scanner (Magnetom Symphony: Siemens) was normal. However, axial TSE T2W (5mm slice thickness with 4mm table feed) revealed retinal detachment with suspicion of a tiny lesion in the postero- lateral quadrant of the right eyeball [Figure - 1]. TSE T2 W AND SE T1 W sequences in coronal and sagittal planes were uninformative. A high resolution CISS (constructive interference in steady state) sequence was performed in axial plane with reconstruction in the sagittal and coronal planes. A well-defined, thin walled cyst was observed along the postero-lateral wall of the right orbit. It measured 0.6 x 0.5cm in size. A tiny eccentric hypointense speck was seen in it suggestive of scolex [Figure - 2]a, b &c.

A diagnosis of intraocular cysticercosis with retinal detachment was made. The patient underwent surgery and the cyst was sucked out. It was intravitreal in location with inflammation in the surrounding tissues. The patient was asymptomatic after surgery.


   Discussion Top


The unique structure of the human eye as well as exposure of the eye directly to the environment renders it vulnerable to a number of uncommon infectious diseases caused by fungi and parasites. Host defenses directed against these microorganisms, once anatomical barriers are breached, are often insufficient to prevent loss of vision.

Therefore, the timely identification and treatment of the involved microorganisms are paramount[1].

Most parasitic infections of the eye arise following blood borne carriage of the microorganism to the eye or adjacent structures [1]. The extra-ocular muscle forms the most common type of orbital cysticercosis[3]. In the ocular form, the favoured sites are the vitreous and the subretinal space[4]. Of 520 cases described by kruger-leite et al., 35 percent were subretinal, 22 percent vitreal cavity, 72 percent retinal and vitreal, 22 percent subconjuctival. In only 5 percent of case were parasites seen in the anterior chamber [5]. Symptoms may include periorbital pain, diplopia, ptosis, blurring or loss of vision, distortion of images, and the sensation of light flashes [1].

Diagnosis of ocular cysticercosis is usually accomplished by direct ophthalamoscopic demonstration of the larval worm. Ultrasound, CT and MRI are other modalities for establishing the diagnosis. MR is however the best tool for intraocular as well as neuro-cysticercosis.

Medical treatment is known to cause severe ocular complications, which may lead to loss of the eye [6]. Hence, the importance of early diagnosis of intraocular cysticercosis.

Routine sequences did not show the intraocular cyst as clearly as the high resolution CISS sequence. A high degree of suspicion and use of correct sequence with thin slices Is highlighted here.

 
   References Top

1.Stephen A. Klotz , Christopher C. Penn, Gerald J. Negvesky and Salim I. Butrus. Fungal and parasitic infection of eye. Clinical Microbiology Reviews. October 2000, vol.13(4): 662-685.  Back to cited text no. 1    
2.Garcia, L., and D. Bruckner . 1997. Diagnostic medical parasitology. 3rd ed. ASM press, Wahington, DC.  Back to cited text no. 2    
3.S. K. Sethi, U. Hemal, R. S. Solanki, and A. Bhagra. Orbital Cysticercosis. Ind J Radiol Imag 2004 14:1:93-94.  Back to cited text no. 3    
4.Pushker N, Bajaj MS, Chandra M, Neena. Ocular and orbital cysticercosis. Acta ophthalmol Scand 2001;79: 408-413.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Kruger-Leite, E., Jalkh, A.E., Quiroz, H., and Schepens, C.L. (1985). Intraocular cysticercosis. American Journal of Ophthalmology, 99, 252-7.  Back to cited text no. 5    
6.Krishna M. Rao, Subhash V. Vargiya, and Neera Kohli. Rapid onset unilateral vision loss by intra-ocular cysticercosis-Demonstrated by MRI. Ind J Radiol Imag1999; 9: 3.  Back to cited text no. 6    

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Correspondence Address:
IBS Nijjar
Nijjar Scan & Diagnostic Centre, Amritsar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.29142

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    Figures

[Figure - 1], [Figure - 2]

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