A case of neurocysticercosis presenting as oculomotor nerve palsy

Abstract

Cysticercosis is a parasitic infestation that results from
ingestion of eggs of adult tapeworm, Taenia solium. When
cysticercosis involves the central nervous system, it is called
neurocysticercosis. Neurocysticercosis is the most common
parasitic infestation of the brain and a leading cause of
epilepsy in the developing world, especially Latin America,
India, Africa, and China. In this case,16 year old male
presented with complaints of sudden onset diplopia and
drooping of left upper eyelid of one month duration.
Evaluation of the patient revealed complete oculomotor nerve
palsy on the left side. Patient was admitted with complaints of
altered sensorium and ventriculo-peritonal shunt done for
dilatation of all ventricles one year before. He was emprically
given anti tuberculous treatment . All investigations were
normal including cerebrospinal fluid analysis on previous
admission. Now the MRI brain showed multiple ring
enhancing lesions at thalamus, midbrain and corpus
callosum. MRI Spectroscopy showed elevated levels of
l a c t a t e wi th i n t h e l e s i o n s suggestive of
neurocysticercosis. Isolated oculomotor nerve palsy is a very
rare manifestation of neurocysticercosis.
Keyword :neurocysticercosis, epilepsy, nerve palsy,
ventriculoperitoneal shunt