Ocular cysticercosis with vitreous hemorrhage: a rare complication of a common disease.

INTRODUCTION: Cysticercosis, a helminthic infestation caused by Taenia solium, can produce central nervous system, muscles, visceral, subcutaneous tissues and skin manifestations. Ophthalmological involvement can affect eyelids, conjunctiva, anterior chamber, uvea, vitreous, retina, extraocular muscles and optic nerve. Simultaneous co-occurrence of intracranial and intraocular cysticercosis is a common presentation in clinical practice. CASE DESCRIPTION: We report a case of young girl who was diagnosed with multiple intracranial neurocysticercosis lesions and was on antiepileptic drugs, following which she presented with progressive painless vision loss from both the eyes. Indirect ophthalmoscopic examination showed evidence of subretinal cysts, retinal hemorrhage and retinal detachment in both the eyes. Surprisingly, bilateral vitreous hemorrhage was also detected. Ocular B-scan ultrasonography, orbital MRI and computed tomography revealed retinal detachment with vitreous hemorrhage in both the eyes. Magnetic resonance imaging (MRI) of brain showed multiple intraparenchymal small cystic lesions in bilateral cerebral and cerebellar hemispheres, basal ganglia, thalami and brainstem. CONCLUSIONS: Vitreous and retinal detachment are well known complications of intraocular cysticercosis, however, vitreous hemorrhage as preoperative feature has never been reported before, although vitreous hemorrhage as postoperative complication is common.

Dyke-Davidoff-Masson syndrome: a clinicoradiological amalgam.

Dyke-Davidoff-Masson syndrome is a relatively rare syndrome with its typical clinical and radiological features including facial asymmetry, hemiplegia, cerebral hemiatrophy, mental retardation with calvarial thickening, hypertrophy of sinuses and elevated petrous ridge on imaging. We present here a case of congenital type Dyke-Davidoff-Masson syndrome with some additional features in the form of microcephaly, hypospadias and pachygyria.

Cysticercotic encephalitis: a life threatening form of neurocysicercosis.

Neurocysticercosis is the most frequent neuroparasitosis and is caused by Taenia solium larvae (cysticerci). Its most common presenting feature is seizure, although it may present as headache,focal deficits, hydrocephalous, or as features of raised intracranial pressure. We herein report a case of 40-year-old male who presented with features of acute encephalitis and raised intracranial pressure with magnetic resonance imaging suggestive of multiple neurocysticerci with diffuse cerebral edema. A diagnosis of cysticercotic encephalitis was made, which is a syndrome of encephalitis with clinical and radiologic evidences of diffuse cerebral edema caused by parenchymal cysticercosis. It is important for the clinicians to be aware of this medical emergency requiring urgent attention as delay may lead to fatal outcome.

Posterior cerebral artery stroke presenting as alexia without agraphia.

Alexia without agraphia (pure alexia) was the first of the disconnection syndromes to be described by Dejerine who reported a patient of alexia without agraphia secondary to an embolic occipital lobe infarct. We herein report a 55-year-old man who presented with alexia without agraphia with magnetic resonance imaging suggestive of left posterior cerebral artery infarct involving left occipital lobe and splenium of corpus callosum. Alexia without agraphia is a relatively uncommon clinical condition, which should always be thought in a patient presenting with difficulty in reading with normal visual acuity. Ophthalmologists should also be aware of this disconnection syndrome as many patients initially take their advice due to predominant visual complaints. Early diagnosis and treatment of this condition help in ensuring the patient and attendants about nonprogressive nature of the disease and may prevent further episodes of stroke.

Intramedullary craniovertebral junction tuberculoma: An uncommon location of a common disease.

Central nervous system involvement is observed in no more than 10% of patients with systemic tuberculosis. Although CNS tuberculosis is not rare in endemic countries, such as India, intramedullary tuberculosis is not commonly reported. In this study, we report a case of a 40-year-old female who presented with a six-year history of insidious onset, gradually progressive, asymmetric quadriparesis. She was diagnosed with intramedullary tuberculoma at the craniovertebral junction and showed significant clinico-radiological improvement with medical management alone. To the best of our knowledge, this report describes the first case of intramedullary tuberculoma at the craniovertebral junction to be reported. With the increased availability of MRI in developing countries, it is now possible for clinicians to diagnose this condition without performing a biopsy. It is important for the clinicians in developed countries to be highly suspicious of intramedullary tuberculoma, as there has been a resurgence of CNS tuberculosis due to the emergence of the HIV pandemic.