Suprasellar Cysticercosis Associated With Partial Third Cranial Nerve Palsy Relieved by Surgical Cyst Removal

ABSTRACT

PURPOSE: To report a case of partial third cranial nerve palsy in a patient with suprasellar cysticercosis. Surgical removal of the cyst was followed by symptom improvement. CASE SUMMARY: A 36-year-old man presented with binocular diplopia for 3 months. His best corrected visual acuities were 20/20 in both eyes, and both slit lamp and fundus examinations were unremarkable. The alternate prism cover test revealed four prism diopters (Delta) of exotropia and 4Delta of left hypotropia. Supraduction and adduction was mildly limited in the left eye. Pupil size was larger in the left eye and anisocoria was greater under bright light. Color test and visual field examination were normal. Neurologic examination showed a weakness of grade IV in the upper and lower extremities. Brain magnetic resonance imaging revealed a well-encapsulated cystic mass of homogeneous low intensity signal in the suprasellar area extending into the midbrain. Craniotomy and cyst removal were performed, and histologic findings were compatible with neurocysticercosis. Two weeks postoperatively the patient was free of diplopia and limb weakness. CONCLUSIONS: Neurocysticercosis of a suprasellar origin may produce mass effects on the midbrain, inducing focal neurologic deficits of partial third cranial nerve palsy along with limb weakness. Masses of suprasellar origin can be successfully treated by surgical removal of the cyst.