Extraocular muscle cysticercosis: a clinical masquerade

PURPOSE: To highlight the different presentations of extraocular muscle cysticercosis, which can result in acquired ocular motility disorders. METHODS: Ten cases of acquired motility disorders examined between January 1998 and January 1999 were diagnosed as extraocular muscle cysticercosis with computed tomography (CT). All patients were treated with corticosteroid therapy and albendazole. Repeat CT scans were performed in 5 patients. RESULTS: The inferior rectus muscle was most commonly affected with double elevator palsy the most common clinical presentation. Response to treatment was satisfactory with complete resolution of the ocular motility disorder in 8 patients. Initiating therapy with corticosteroids prior to the addition of cysticidal drugs prevented severe inflammatory reactions and residual strabismus. CONCLUSION: A high index of suspicion should be entertained for extraocular muscle cysticercosis in every case of recent acquired ocular motility disorder. Response to medical therapy is satisfactory.     

Cysticercosis. A modern day plague

The authors describe the magnitude of the cysticercosis problem and describe the organism, the clinical features of the disease, the propensity of the organism for development in the central nervous system, pathologic considerations, clinical diagnosis, and treatment.     

Atypical presentations of orbital cysticercosis

We describe three patients with orbital cysticercosis who presented with atypical clinical or radiologic features previously unreported. All three patients had a cyst with a scolex on imaging studies. After 6 weeks of treatment, all three had almost complete resolution of their features.     

Extraocular muscle cysticercosis: clinical presentations and outcome of treatment

PURPOSE: To report various clinical presentations and treatment outcomes in a series of patients with extraocular muscle cysticercosis. METHODS: This retrospective study reviewed the charts of 43 patients diagnosed with extraocular muscle cysticercosis with computed tomography and orbital B-scan ultrasonography between January 1991 and December 2002. Clinical presentation, results of investigations, treatment, and outcome were recorded. RESULTS: The superior rectus was the most commonly affected extraocular muscle. Restricted ocular motility was present in 88% of patients, and inflammatory signs were noted in the involved quadrant in 70% of patients. Eleven patients were treated with oral albendazole alone and 31 patients were treated with oral albendazole and prednisolone. Four extraocular muscle cysts were excised surgically, and five extruded spontaneously. Inflammatory signs subsided in all patients, and residual restriction of ocular motility was seen in 16 (50%) of 32 patients at a mean follow-up of 5 months. Type of treatment made no significant difference in the ocular motility outcome. CONCLUSIONS: Extraocular muscle cysticercosis should be considered in patients who present with restricted ocular motility and inflammatory signs. The direction of motility restriction does not indicate the muscle involved. Residual restriction of ocular motility is common despite the addition of corticosteroids to albendazole therapy.     

Orbital cysticercosis: diagnosis and treatment controversies

Orbital cysticercosis is a rare condition and its management is controversial. We report 2 cases of orbital cellulitis associated with cysticercosis in which the treatment with antihelminthics was withheld. The 2 children had good evolution with spontaneous progressive resolution. The current literature is reviewed.     

Isolated cardiac cysticercosis in an adolescent

Cardiac cysticercosis is a rare and typically asymptomatic infection. We report a case of a young man from Cameroon with a left ventricular cyst discovered during a screening echocardiogram. Computed tomography and plain films did not reveal additional cysts. Serology was negative. The patient had the cyst surgically removed for suspected echinococcosis. Sectioning demonstrated a cysticercus. The literature on cardiac cysticercosis is reviewed.     

Cerebral cysticercosis in children in South Africa

Sixty-one children with cerebral cysticercosis are presented. The commonest clinical manifestation was epilepsy with or without focal signs in 43% of children, followed by the syndrome of raised intracranial pressure in 34% and meningoencephalitis in 13%. The CT scan was positive in 93% of cases and the HAI test in 86% of children so examined. Both were positive in 80%. Skull X-ray revealed evidence of calcification and/or raised intracranial pressure in 60%. Two children died, one each with subacute sclerosing panencephalitis and tuberculous meningitis. Of those who improved on discharge, 43% had epilepsy and 32% neurological deficit of an obvious nature. The parasitology, pathogenesis, pathology and diagnosis of cerebral cysticercosis are briefly reviewed. Present therapy and the suggested use of a specific anti-cysticeral drug are discussed. Case histories are presented to draw attention to the variability of the clinical picture and the particular importance of recognising the acute parenchymatous form of the disease in children which may present with critically elevated intracranial pressure.     

Cerebral cysticercosis: treatment with praziquantel

An infant with cerebral cysticercosis had marked clinical and radiographic improvement following treatment with praziquantel. Computed tomographic appearance and radioimmunoassay were helpful in establishing the diagnosis. Disappearance or size reduction of all active lesions were documented by computed tomography 6 months after praziquantel treatment. Simultaneous administration of dexamethasone during praziquantel treatment is essential to prevent reactive cerebral edema during treatment.     

Neurocysticercosis in an 8-year-old girl]

We report about an 8-year-old girl with signs of elevated intracranial pressure. X-ray, CT and MRT scan showed an inner hydrocephalus as well as an intracranial calcification. By western blot analysis a Taenia solium cysticercosis could be diagnosed. In spite of spontaneous remission of the symptoms we treated with Praziquantel. Resection of the cyst was not necessary. Diagnostic and therapeutic problems of cysticercosis are discussed.     

Disseminated cysticercosis in a child: whole-body MR diagnosis with the use of parallel imaging

Cysticercosis is a parasitic disease caused by infestation with the encysted larval stage of the pork tapeworm, Taenia solium. Disseminated cysticercosis is an exceptional expression of this disease characterized by high morbidity due to massive symptomatic parasite burden in the central nervous system, striated muscles, subcutaneous tissues and other organs. Less than 50 such cases have been reported worldwide, and fewer than 10 children. We report on the whole-body MR diagnosis of extensively disseminated cysticercosis in a child. The critical role of whole-body MR as a stand-alone modality in the diagnosis and management of this pleomorphic disease is highlighted. Whole-body MR diagnosis of an infectious disease is unique.     

Rathke's cleft cyst: missed etiology of panhypopituitarism in presence of coexistent ocular and neurocysticercosis

We report a 10 year-old girl with panhypopituitarism and coexistent ocular and neurocysticercosis. Intrasellar cystic lesions whether neoplastic or non-neoplastic in origin are often difficult to distinguish because their symptoms, signs, and radiological characteristics are similar. The diagnosis of intrasellar cysticercosis was initially considered because of high endemicity, positive serology for cysticercus and radiological evidence of cysticercosis in the eye and parietal lobe. However, since there was no improvement with cysticidal therapy and no radiological resolution of the sellar lesion, surgery was performed, which revealed a Rathke's cleft cyst.     

Cerebral cysticercosis.

A case of cerebral cysticercosis in an American child is described. The patient was only 2 years old and had never left the United States. Her symptoms began with febrile seizures and progressed to focal motor seizures. Cerebrospinal fluid pleocytosis with eosinophilia, candle-guttering of the walls of the ventricles on pneumoencephalography, and a titer of 1:4,096 against cysticercosis antigen in her blood led to the diagnosis. Over a five-year follow-up period, the patient's course has been one of resolution of her symptoms, improvement in her electroencephalogram, and excellent seizure control with anticonvulsant therapy. Cysticercosis should be considered in the differential diagnosis of a child who shows CSF pleocytosis with eosinophilia, particularly if accompanied by focal seizures.     

Optic nerve cysticercosis

Optic nerve cysticercosis is rare but causes significant visual morbidity. A high index of suspicion is warranted for patients in endemic areas who present with sudden vision loss. Visual morbidity can be prevented by early imaging studies and therapeutic interventions.     

Magnetic resonance imaging in childhood epilepsy.

One hundred and seventy children of chronic seizures with strong clinical suspicion of an underlying intracranial lesion as its cause were studied by Magnetic Resonance Imaging (MRI). Maximum number of patients were between 6-12 years, males outnumbering females. Structural abnormalities were seen in 158 of the 170 patients. The study revealed tuberculoma as the commonest lesion in this series (n = 64) followed by cysticercosis (n = 27). Three patients were seen to have glioma. An interesting finding was disappearing lesion in 6 children. MRI proved to be an excellent modality in demonstrating and characterising the intracranial lesion.     

Intraparenchymal cerebral cysticercosis in children: diagnosis and treatment

Cerebral cysticercosis is being diagnosed with increasing frequency in children in the United States. A total of 52 patients with intraparenchymal cerebral cysticercosis, 21 months to 20 years of age, were observed for 2 to 72 months. Actively inflamed acute lesions, with or without coexisting chronic calcified lesions, were seen in 42 patients. Solitary lesions were seen in 39 patients, multiple lesions in 13. Chronic inactive calcified lesions were seen in ten children. A total of 51 patients had seizures that were either partial or partial with secondary generalization. Patients were treated with anticonvulsants. Praziquantel was not used. All active lesions resolved completely or with punctate calcification in 2 to 9 months, according to radiographic findings. Seizures were easily controlled. Patients were gradually weaned from anticonvulsants and in 60% no seizures recurred. Prognosis was generally good. Characteristics of the CT scans are detailed.     

Unifocal, subconjunctival twin cysticercosis cysts

We report a case of multiple, unifocal, subconjunctival cysticercosis in an 8-year-old boy. Two cysts, each with a scolex, were in the subconjunctival space. They were removed surgically, and histopathologically proven to be Cysticercus cellulosae. This is only the second report of twin cysticercus in the literature, to the best of our knowledge.     

Spinal intramedullary cysticercosis in a five-year-old child: case report and review of the literature.

Spinal intramedullary cysticercosis is rare and usually afflicts adults. We report the case of a 5-year-old Mexican girl with back pain who had a complex thoracic spinal intramedullary mass on magnetic resonance imaging and a positive immunoblot for Taenia solium. Surgery revealed a cystic mass containing a cysticercus. Cysticercosis should be suspected as the cause of an intramedullary spinal mass in a patient from an endemic area.     

Cerebral cysticercosis. Apropos of a case treated with praziquantel

The authors report a case of cerebral cysticercosis in a 17 year-old adolescent. Partial seizures and moderate functional signs of intracranial hypertension were the presenting symptoms. Treatment with Praziquantel under corticosteroid therapy was successful with almost complete disappearance of radiologic abnormalities on the computerised tomographic examination performed 7 months after the end of treatment.     

Ultrasonography for masseter muscle cysticercosis

Solitary cheek swellings can present a diagnostic dilemma. We managed two children 10 y and 8 y presenting with pain and swelling on one side of cheek for over 15 d and no constitutional symptoms. Sonography showed cysticercosis in both of them. We treated both with steroids and albendazole, with good response.     

Neurocysticercosis: Controversies in management

Cysticercosis is a major cause of neurologic disease worldwide that is now increasingly recognized in the United States. Seizures are the most prominent symptom of central nervous system involvement. Current therapeutic interventions include the use of anticonvulsants, surgery, corticosteroids, and antiparasitic drugs, such as albendazole and praziquantel. Although antiparasitic drugs can kill the cysticerci, controlled trials in parenchymal neurocysticercosis have so far failed to document a clear clinical benefit. Further, antiparasitic drugs may actually result in neurologic deterioration in some patients. Therefore, therapy should be individualized based on the location of the cysticerci, the degree of host inflammatory response, the presumed pathogenesis, and the anticipated natural history. The objective of this article is to advance principles and standard approaches for the therapeutic intervention of neurocysticercosis. In addition, we review the pathogenesis and the natural history of cysticercosis, which provide the foundation for the management of its neurologic complications. Copyright © 2000 by W.B. Saunders Company