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1.
BMJ Case Rep ; 20182018 Jun 08.
Article in English | MEDLINE | ID: mdl-29884714

ABSTRACT

A young male patient presented to our ocular emergency department with chief complaints of progressive pain, redness, diplopia and a right-sided face turn. Ocular examination revealed severely restricted extraocular movements along with retinal folds in the left eye. Initial orbital ultrasound and CT findings were equivocal; however, serology favoured an infective cause. Considering the endemicity of the disease and equivocal investigation findings, a diagnosis of orbital cysticercosis with an atypical presentation was made. The patient was managed medically with a combination of oral albendazole and steroids over a period of 6 weeks to achieve optimal results.


Subject(s)
Cysticercosis/diagnosis , Ocular Motility Disorders/diagnosis , Oculomotor Muscles/diagnostic imaging , Orbit/diagnostic imaging , Orbital Diseases/diagnostic imaging , Adult , Albendazole/administration & dosage , Albendazole/therapeutic use , Antiprotozoal Agents/therapeutic use , Cysticercosis/drug therapy , Cysticercosis/parasitology , Diagnosis, Differential , Diplopia/diagnosis , Diplopia/etiology , Endemic Diseases , Eye Infections, Parasitic/diagnosis , Eye Infections, Parasitic/drug therapy , Eye Infections, Parasitic/parasitology , Glucocorticoids/therapeutic use , Humans , Male , Ocular Motility Disorders/drug therapy , Ocular Motility Disorders/parasitology , Oculomotor Muscles/parasitology , Oculomotor Muscles/pathology , Oculomotor Muscles/physiopathology , Orbit/pathology , Orbital Diseases/drug therapy , Orbital Diseases/parasitology , Orbital Diseases/pathology , Prednisolone/administration & dosage , Prednisolone/therapeutic use , Tomography, X-Ray Computed/methods , Treatment Outcome , Ultrasonography/methods
2.
Arq Bras Oftalmol ; 70(3): 537-9, 2007.
Article in English | MEDLINE | ID: mdl-17768567

ABSTRACT

Presentation of one case of extraocular muscle enlargement caused by cysticercosis, its clinical, diagnostic and treatment aspects, and review of the literature on this theme. A female 38-year-old patient with extraocular muscle enlargement and a small cystic lesion at the superior rectus muscle insertion was treated with oral prednisone for almost one year, with a non-specific inflammation of right orbit diagnosis. There were important ocular motility restriction and pain. Computerized tomography disclosed a superior rectus muscle thickening with a small cystic and apparently empty lesion at the muscle's insertion. Excisional biopsy and histopathological study confirmed the clinical suspicion of cysticercosis. There was partial resolution of the restricted motility. Extraocular muscle cysticercosis is the most common site of this disease when involving the orbit. Oral albendazole and prednisone are efficient, but a long history of disease can lead to important residual ocular motility restriction.


Subject(s)
Cysticercosis/diagnosis , Eye Infections, Parasitic/diagnosis , Orbital Diseases/diagnosis , Adult , Albendazole/therapeutic use , Anthelmintics/therapeutic use , Cysticercosis/drug therapy , Diagnosis, Differential , Eye Infections, Parasitic/drug therapy , Female , Humans , Inflammation/diagnosis , Ocular Motility Disorders/parasitology , Oculomotor Muscles/parasitology , Prednisone/therapeutic use , Tomography, X-Ray Computed
3.
Arq. bras. oftalmol ; 70(3): 537-539, maio-jun. 2007. ilus
Article in English | LILACS | ID: lil-459847

ABSTRACT

Presentation of one case of extraocular muscle enlargement caused by cysticercosis, its clinical, diagnostic and treatment aspects, and review of the literature on this theme. A female 38-year-old patient with extraocular muscle enlargement and a small cystic lesion at the superior rectus muscle insertion was treated with oral prednisone for almost one year, with a non-specific inflammation of right orbit diagnosis. There were important ocular motility restriction and pain. Computerized tomography disclosed a superior rectus muscle thickening with a small cystic and apparently empty lesion at the muscle's insertion. Excisional biopsy and histopathological study confirmed the clinical suspicion of cysticercosis. There was partial resolution of the restricted motility. Extraocular muscle cysticercosis is the most common site of this disease when involving the orbit. Oral albendazole and prednisone are efficient, but a long history of disease can lead to important residual ocular motility restriction.


Apresentação de um caso de aumento de músculo extra-ocular causado por cisticercose, seus aspectos diagnósticos, clínicos, tratamento e revisão da literatura sobre o tema. Paciente de 38 anos do sexo feminino com aumento de músculo reto superior e pequena lesão cística foi tratada por um ano com prednisona oral com o diagnóstico de inflamação inespecífica da órbita. Havia importante restrição da motilidade ocular e dor. Tomografia computadorizada demonstrou espessamento do reto superior e pequena lesão cística, aparentemente sem conteúdo, na inserção do músculo. Biópsia excisional e estudo histopatológico confirmaram a suspeita de cisticercose. Houve melhora parcial da restrição de motilidade. A cisticercose de músculo extra-ocular é a mais frequente forma orbitária da doença. Tratamento clínico com albendazol e prednisona é eficiente, mas um atraso no diagnóstico pode levar a importante restrição residual na motilidade ocular.


Subject(s)
Adult , Female , Humans , Cysticercosis/diagnosis , Eye Infections, Parasitic/diagnosis , Orbital Diseases/diagnosis , Albendazole/therapeutic use , Anthelmintics/therapeutic use , Cysticercosis/drug therapy , Diagnosis, Differential , Eye Infections, Parasitic/drug therapy , Inflammation/diagnosis , Ocular Motility Disorders/parasitology , Oculomotor Muscles/parasitology , Prednisone/therapeutic use , Tomography, X-Ray Computed
6.
J Pediatr Ophthalmol Strabismus ; 42(1): 28-33, 2005.
Article in English | MEDLINE | ID: mdl-15724896

ABSTRACT

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.


Subject(s)
Cysticercosis/diagnosis , Eye Infections, Parasitic/diagnosis , Ocular Motility Disorders/diagnosis , Oculomotor Muscles/parasitology , Adolescent , Adult , Albendazole/therapeutic use , Antiprotozoal Agents/therapeutic use , Child , Child, Preschool , Cysticercosis/parasitology , Cysticercosis/therapy , Drug Therapy, Combination , Eye Infections, Parasitic/parasitology , Eye Infections, Parasitic/therapy , Female , Glucocorticoids/therapeutic use , Humans , Male , Ocular Motility Disorders/parasitology , Ocular Motility Disorders/therapy , Ophthalmologic Surgical Procedures , Prednisolone/therapeutic use , Retrospective Studies , Treatment Outcome
7.
Orbit ; 23(4): 255-62, 2004 Dec.
Article in English | MEDLINE | ID: mdl-15590528

ABSTRACT

PURPOSE: To report our experience with extraocular myocysticercosis, to highlight the role of ultrasound and orbital computerized tomography (CT) scan in these cases and to discuss the management. METHODS: This is retrospective study of 35 cases of orbital myocysticercosis confirmed on ultrasound and CT scan of the orbit. RESULTS: There were 18 males and 17 females. The average age of these patients was 19.6 years. The most common presenting feature was restricted ocular motility with diplopia and recurrent pain and redness. Ultrasound examination and CT scan of the orbit done for all these patients identified the cyst and the affected muscle. All extraocular muscles were noted to be involved in myocysticercosis. However the lateral rectus, medial rectus and the superior oblique were affected to a greater extent. All cases dramatically improved on treatment with albendazole and oral steroids. Surgical excision of cyst was done in 6 cases. CONCLUSION: A high index of suspicion should be entertained for extraocular muscle cysticercosis, especially in cases of acquired ocular motility disorder with recurrent ocular congestion. Ultrasound and CT scans of orbit play a vital role in diagnosis. Medical therapy with albendazole under cover of steroids is effective in most of the cases.


Subject(s)
Cysticercosis/diagnosis , Eye Infections, Parasitic/diagnosis , Ocular Motility Disorders/diagnosis , Oculomotor Muscles/parasitology , Adolescent , Adult , Albendazole/therapeutic use , Antiprotozoal Agents/therapeutic use , Child , Child, Preschool , Cysticercosis/drug therapy , Cysticercosis/parasitology , Diplopia/diagnosis , Diplopia/parasitology , Eye Infections, Parasitic/drug therapy , Eye Infections, Parasitic/parasitology , Female , Humans , Male , Ocular Motility Disorders/drug therapy , Ocular Motility Disorders/parasitology , Oculomotor Muscles/drug effects , Orbit/diagnostic imaging , Pain/diagnosis , Pain/parasitology , Retrospective Studies , Tomography, X-Ray Computed , Ultrasonography
8.
J AAPOS ; 7(1): 23-7, 2003 Feb.
Article in English | MEDLINE | ID: mdl-12690365

ABSTRACT

BACKGROUND: Acquired Brown syndrome is known to occur after trauma, iatrogenic events, cysts of superior oblique muscle tendon, and inflammation. The purpose of this study is to report a large series of patients with acquired Brown syndrome secondary to superior oblique muscle cysticercosis and to discuss its management. METHODS: Retrospective analysis was performed of clinical and imaging features, management, and outcome in seven patients with cysticercosis of the superior oblique muscle presenting clinically as Brown syndrome. RESULTS: Seven patients were identified (five male and two female) ranging in age from 6 to 45 years. All patients had the ocular motility limitation, ie, limitation of elevation in adduction., characteristic of Brown syndrome. This was associated with pain and swelling in the superior nasal orbit. Diagnosis was established by observing the cysticercus cyst with scolex on imaging (ultrasound B scan, magnetic resonance imaging, and/or computed tomography). Oral albendazole (15 mg/kg) and oral prednisolone (1mg/kg) were given for 4 weeks, and the patients were followed up for 1 year. Clinical recovery with improvement of ocular motility and regression of imaging features was noted in all patients. CONCLUSIONS: Acquired Brown syndrome secondary to superior oblique muscle cysticercosis is a rare entity. Awareness of this condition, which leads to early diagnosis and institution of prompt medical treatment, results in a successful clinical outcome.


Subject(s)
Cysticercosis/complications , Ocular Motility Disorders/parasitology , Oculomotor Muscles/parasitology , Adolescent , Adult , Anthelmintics/therapeutic use , Child , Cysticercosis/drug therapy , Female , Fixation, Ocular , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Ocular Motility Disorders/diagnosis , Ocular Motility Disorders/physiopathology , Retrospective Studies , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography
9.
Am J Ophthalmol ; 135(1): 98-9, 2003 Jan.
Article in English | MEDLINE | ID: mdl-12504708

ABSTRACT

PURPOSE: To describe a unique case of orbital hydatid cyst that was located solely within the medial rectus muscle. DESIGN: Retrospective, interventional case report. METHODS: A 20-year-old woman presented with right periocular pain induced by ocular movements. Magnetic resonance imaging studies showed a focal, well-circumscribed intramuscular cystic lesion of the right medial rectus muscle. The cyst was completely extirpated from the muscle, but some of the fluid content escaped into the surrounding tissues. Irrigation with hypertonic saline was performed. RESULTS: Histopathologic examination showed an acellular cyst wall with inner germinal layer, diagnostic for hydatid cyst. Two cycles of oral albendazole were administered with no recurrence. CONCLUSIONS: In the orbit, hydatid cyst may be localized primarily within an extraocular muscle and produce painful eye movements. Hydatid cyst must be considered in the differential diagnosis of solitary cystic enlargements of extraocular muscles.


Subject(s)
Echinococcosis/parasitology , Eye Infections, Parasitic/parasitology , Ocular Motility Disorders/parasitology , Oculomotor Muscles/parasitology , Adult , Albendazole/therapeutic use , Antiprotozoal Agents/therapeutic use , Echinococcosis/diagnosis , Echinococcosis/therapy , Eye Infections, Parasitic/diagnosis , Eye Infections, Parasitic/therapy , Female , Humans , Magnetic Resonance Imaging , Ocular Motility Disorders/diagnosis , Ocular Motility Disorders/therapy , Oculomotor Muscles/pathology , Oculomotor Muscles/surgery , Ophthalmologic Surgical Procedures , Retrospective Studies
10.
Am J Ophthalmol ; 131(4): 526-7, 2001 Apr.
Article in English | MEDLINE | ID: mdl-11292430

ABSTRACT

PURPOSE: Report of a case of acquired Brown syndrome caused by infestation of the superior oblique muscle by Cysticercus cellulosae. METHOD: Case seen in a referral practice. A 20-year-old man presented with recurrent attacks of conjunctivitis and diplopia in upgaze. Clinical examination of ocular motility established a diagnosis of acquired Brown syndrome of the right eye. Computed tomography of the right orbit unequivocally established the diagnosis of superior oblique muscle cysticercosis. The patient was started on systemic steroids and albendazole in the prescribed doses for a month. RESULT: Serial computed tomography scans of the orbit revealed resolution of the cystic lesion after a month. Clinically, although there was restoration of ocular motility in upgaze, mild restriction of movement of the right eye in levoelevation persisted. However, the patient was symptomatically better with amelioration of the recurrent conjunctivitis and diplopia in primary gaze. CONCLUSION: Extraocular muscle cysticercosis should be considered in the differential diagnosis of acquired motility disorder. The presentation of extraocular muscle cysticercosis as an acquired Brown syndrome is unusual. Response to medical therapy was satisfactory.


Subject(s)
Cysticercosis/diagnostic imaging , Eye Infections, Parasitic/diagnostic imaging , Ocular Motility Disorders/diagnostic imaging , Ocular Motility Disorders/parasitology , Oculomotor Muscles/parasitology , Adult , Albendazole/therapeutic use , Antiprotozoal Agents/therapeutic use , Cysticercosis/drug therapy , Drug Therapy, Combination , Eye Infections, Parasitic/drug therapy , Glucocorticoids/therapeutic use , Humans , Male , Ocular Motility Disorders/drug therapy , Oculomotor Muscles/diagnostic imaging , Oculomotor Muscles/drug effects , Syndrome , Tomography, X-Ray Computed
11.
East Afr Med J ; 76(7): 417-8, 1999 Jul.
Article in English | MEDLINE | ID: mdl-10520374

ABSTRACT

We report two cases of post malarial cerebellar ataxia presenting with severe ocular flutter, in a female of 72 years and a male of 20 years. Both patients had falciparum malaria infection. CT scans of both patients were within normal limits for the age. Cerebellar signs as well as ocular flutter responded very well to moderate doses of prednisolone therapy.


Subject(s)
Cerebellar Ataxia/parasitology , Malaria, Falciparum/complications , Ocular Motility Disorders/parasitology , Adult , Aged , Anti-Inflammatory Agents/therapeutic use , Antimalarials/therapeutic use , Cerebellar Ataxia/diagnostic imaging , Cerebellar Ataxia/drug therapy , Drug Therapy, Combination , Female , Humans , Malaria, Falciparum/drug therapy , Male , Ocular Motility Disorders/diagnostic imaging , Ocular Motility Disorders/drug therapy , Prednisolone/therapeutic use , Tomography, X-Ray Computed
12.
Am J Ophthalmol ; 121(4): 438-41, 1996 Apr.
Article in English | MEDLINE | ID: mdl-8604738

ABSTRACT

PURPOSE: We treated two patients who had spontaneous extrusion of cysticercus cysts and subconjunctival swelling. Additionally, one patient had severe myositis and restriction of ocular movements. METHODS: The patients were prescribed oral albendazole, 15 mg/kg of body mass per day. Systemic corticosteroids were also given to the patient who had severe myositis. RESULTS: Spontaneous extrusion of the cysts occurred in both patients within three to five days of starting albendazole therapy. The conjunctival defects healed without any surgical intervention. The ocular motility in the patient with myositis returned to normal. CONCLUSION: As extrusion happened soon after the start of albendazole therapy, it is uncertain whether this therapy played any role. Additionally, it is not clear if systemic therapy must be continued in the absence of systemic and neurologic manifestations.


Subject(s)
Conjunctivitis/parasitology , Cysticercosis/etiology , Cysticercus/isolation & purification , Eye Infections, Parasitic/etiology , Myositis/parasitology , Ocular Motility Disorders/parasitology , Adult , Albendazole/therapeutic use , Animals , Anthelmintics/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Child , Conjunctiva/parasitology , Conjunctivitis/diagnosis , Conjunctivitis/drug therapy , Cysticercosis/diagnosis , Cysticercosis/drug therapy , Eye Infections, Parasitic/diagnosis , Eye Infections, Parasitic/drug therapy , Female , Humans , Myositis/diagnosis , Myositis/drug therapy , Ocular Motility Disorders/diagnosis , Ocular Motility Disorders/drug therapy , Oculomotor Muscles/parasitology , Steroids , Tomography, X-Ray Computed
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