Table of Contents  
COMMENTARY
Year : 2015  |  Volume : 8  |  Issue : 2  |  Page : 212-213  

Neurocysticercosis and proptosis


Faculty of Medicine, University of Nis, Serbia; Hainan Medical University, China; Joseph Ayobabalola University, Serbia; Surin Rajabhat University, Thailand; Dr. DY Patil Medical College, India

Date of Web Publication13-Mar-2015

Correspondence Address:
Viroj Wiwanitkit
Wiwanitkit House, Bangkhae, Bangkok - 10160, Thailand

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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Wiwanitkit V. Neurocysticercosis and proptosis. Med J DY Patil Univ 2015;8:212-3

How to cite this URL:
Wiwanitkit V. Neurocysticercosis and proptosis. Med J DY Patil Univ [serial online] 2015 [cited 2020 Nov 25];8:212-3. Available from: https://www.mjdrdypu.org/text.asp?2015/8/2/212/153167

Sir,

Cysticercosis is a common tissue parasitic infestation that can be seen in many tropical countries. The cysticercosis can infiltrate in any tissue of the patient, and the infestation can be silent and last long. The diagnosis of cysticercosis is usually by chance. The accidental finding of tissue parasitic cyst and further histopathological examination lead to the confirmation of cysticercosis. Of several infiltration sites, an important site is within central nervous system. This specific kind of cysticercosis is called neurocysticercosis. The neurocysticercosis can lead to several neurological problems, and it can be a deadly medical condition. [1] In general, the patients with neurocysticercosis might present with seizure. Furthermore, the increased intracranial pressure can be seen in the case with obstruction of cerebrovascular fluid flow. The diagnosis of the neurocysticercosis is usually late. The patient usually gets the neurological manifestation, and the neurological imagining investigation is the basic tool that leads to final diagnosis. [1]

However, the neurological problem can be sometimes difficult to diagnose. Some uncommon presentations can lead to difficulty in diagnosis such as the ocular presentation in the recently reported case by Singh et al. [2] Bilateral proptosis in the present case report is very interesting. In fact, cysticercosis can occur at eye and this specific kind of cysticercosis is called ocular cysticercosis. [3] The proptosis can be a presentation of the patient with ocular cysticercosis. However, as Szabo et al. noted, "orbital involvement, in which the parasite localizes within the extraocular muscle is rare". [4] The common sites are "subconjunctival, subretinal and intravitreal structures". [4] In the case with parasitic infestation in orbit, the extraocular muscle involvement can be possible. This can lead to the problem of proptosis. [5],[6] The accompanied symptoms such as strabismus and diminution of vision can be seen. [6] It is no doubt that an important differential diagnosis for proptosis in any patients in the tropical endemic area should cover ocular cysticercosis. However, the neurological problems that can cause proptosis must not be forgotten. Of those neurological problems, in an endemic area, the neurocysticercosis must be included into the differential diagnosis.

The interesting key feature for the case of ocular cysticercosis with orbital involvement and proptosis is the problem is usually unilateral. [5] Hence, the bilateral proptosis as seen in the present case [2] should be sought for the neurological origin of the problem. Nevertheless, the condition that both neurological cysticercosis and ocular cysticercosis occur in the same patient is also possible. The problem of disseminated cysticercosis must be kept in mind in dealing with any cases with identified cysticercosis. [7],[8]

 
  References Top

1.
Wiwanitkit V. Neurocysticercosis: Fireflies in the central nervous system. Am J Electroneurodiagnostic Technol 2010;50:245.  Back to cited text no. 1
    
2.
Singh AK, Agrawal PK, Ahmad J, Gautam A. Bilateral proptosis as a rare manifestation of neurocysticercosis. Med J DY Patil Univ 2015;8:206-8.  Back to cited text no. 2
    
3.
Wiwanitkit S, Wiwanitkit V. Intraocular cysticercosis. Ocul Immunol Inflamm 2012;20:61.  Back to cited text no. 3
    
4.
Szabo B, Popescu L, Szabo I, Opincariu I. Diagnosis of orbital cysticercosis - A challenge for ophthalmologist. Oftalmologia 2012;56:59-64.  Back to cited text no. 4
    
5.
Prasad R, Bagri N, Mishra OP, Singh MK. Proptosis of eyeball in children with medial rectus cysticercosis: Report of 2 cases. Eur J Ophthalmol 2010;20:240-2.  Back to cited text no. 5
    
6.
Taksande B, Jajoo U, Yelwatkar S, Ashish J. Unusual presentation of orbital cysticercosis-ptosis, diminution of vision and medial rectus weakness: A case report. Cases J 2009;2:7025.  Back to cited text no. 6
    
7.
Singh UK, Prasad R, Bhushan P, Mishra OP. Disseminated cysticercosis with a right common femoral vein thrombosis. BMJ Case Rep 2013;2013. doi: 10.1136/bcr-2012-008175.  Back to cited text no. 7
    
8.
Pushker N, Bajaj MS, Chandra M, Neena. Ocular and orbital cysticercosis. Acta Ophthalmol Scand 2001;79:408-13.  Back to cited text no. 8
    




 

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