ABSTRACT
We describe a patient presenting with vertical one-and-a-half syndrome and concomitant contralesional horizontal gaze paresis as the result of a solitary neurocysticercosis (NCC) lesion in the right midbrain extending into the thalamomesencephalic junction. The patient received an albendazole-dexamethasone course which resulted in resolution of his symptoms. The neuro-ophthalmological complications of NCC are reviewed and the clinical topography of the neuro-ophthalmological findings of this unusual observation are discussed.
Subject(s)
Diplopia/etiology , Neurocysticercosis/complications , Nystagmus, Pathologic/etiology , Ocular Motility Disorders/etiology , Oculomotor Nerve Diseases/etiology , Abducens Nerve Diseases/diagnosis , Adult , Albendazole/therapeutic use , Anthelmintics/therapeutic use , Blepharoptosis/etiology , Dexamethasone/therapeutic use , Diagnosis, Differential , Diplopia/drug therapy , Drug Therapy, Combination , Headache/etiology , Humans , Male , Mesencephalon/parasitology , Mesencephalon/physiopathology , Neurocysticercosis/diagnosis , Neurocysticercosis/drug therapy , Neurocysticercosis/physiopathology , Nystagmus, Pathologic/drug therapy , Ocular Motility Disorders/drug therapy , Oculomotor Nerve Diseases/diagnosis , Oculomotor Nerve Diseases/drug therapy , Oculomotor Nerve Diseases/parasitology , Reflex, Abnormal , Thalamus/parasitology , Thalamus/physiopathologyABSTRACT
Brainstem alone is involved very infrequently in patients with neurocysticercosis; usually, it occurs in association with disseminated form of the disease. Isolated involvement of the third nerve is commonly due to vascular causes. We are reporting a case due to cysticercus lesion presenting as isolated third-nerve involvement with sparing of the pupil. The diagnosis of neurocysticercosis was established by the presence of characteristic granulomatous lesions in the midbrain along with positive ELISA for cysticercal antigen in the cerebrospinal fluid. The patient responded well to corticosteroids with almost complete recovery. A follow-up MRI scan showed a significant decrease in the size of the lesion.
Subject(s)
Mesencephalon/parasitology , Neurocysticercosis/complications , Oculomotor Nerve Diseases/parasitology , Taenia solium/isolation & purification , Animals , Diagnosis, Differential , Humans , Male , Mesencephalon/pathology , Neurocysticercosis/drug therapy , Neurocysticercosis/pathology , Oculomotor Nerve Diseases/drug therapy , Oculomotor Nerve Diseases/pathology , Young AdultABSTRACT
Isolated third cranial nerve palsy is usually due to vascular causes like posterior communicating artery aneurysm and it is rare in neurocysticercosis. Third cranial nerve palsy in neurocysticercosis is usually caused by supratentorial or sub-arachnoid lesions with accompanying hydrocephalus or meningitis. We report a patient who presented with isolated third cranial nerve palsy without any other brainstem signs caused by neurocysticercosis involving the midbrain.
