Neurocysticercosis is a life-threatening illness. It has myriads of manifestations and includes seizures, headache and focal neurological deficits. Unusual manifestations are stroke, visual loss, ataxia, dystonia, dementia and hydrocephalus.2 4
Cysticercal granuloma as cause of Weber's syndrome and ptosis5
have also been reported. Cerebral infarction may result from obstruction of small terminal arteries or vasculitis. Intraventricular (5–10%) and meningeal cysticerosis are associated with hydrocephalus, signs of meningeal irritation and raised intracranial pressure. Our patient had cysticercal encephalitis with cortical blindness.
Liberation of cytokines either due to natural degeneration of active cysts or death due to albendazole therapy may lead to increase in body temperature, raised intracranial pressure and intractable seizure. Neuro-retinitis and occipital lobe syndrome has been reported in four patients of neurocysticercosis.6
This is possibly the second case report of cysticercal encephalitis with cortical blindness.
CT scan and MRI are useful in anatomical localisation of cysts, but MRI cranium is more sensitive in picking up active lesions. Our case fulfilled the diagnostic criteria of neurocysticercosis.7
Patients with active cysts remain at risk of serious complication. Therefore, all patients with multiple cysts should receive treatment with steroid to reduce intracranial pressure and cysticidal drug, that is, albendazole. Efficacy of treatment should be monitored by repeat CT and MRI after 3 months.
This report highlights the importance of suspecting neurocysticercosis in cases presenting conditions like encephalitis in tropical countries and not to start albendazole without proper evaluation.
- Cysticercosis is common in tropical countries, including India.
- Cysticercal encephalitis is rare as presentation of neurocysticercosis.
- Neurocysticercosis resulting in cortical blindness is extremely rare.