Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 52, Num. 3, 2004, pp. 402-402

Neurology India, Vol. 52, No. 3, July-September, 2004, pp. 402

Letter To Editor

Recurrent oculomotor nerve palsy: A rare presentation of neurocysticercosis

Mokta JK, Mahajan Sanjay, Machhan Prem, Mokta KiranK, Patial RK, Prashar BS

Departments of Medicine, IGMC, Shimla

Correspondence Address:Departments of Medicine, Dr. Rajendra Prasad Medical College and Hospital, Tanda, H. P

Code Number: ni04139

Sir,
A non-diabetic, non-hypertensive, 34-year-old male presented with sudden onset of complete ptosis of left eye and partial ptosis of right eye of one day duration. He denied diplopia, headache, orbital pain, visual impairment or any weakness of body. Three months ago, he had similar symptoms, which recovered spontaneously by the fourth day. On examination, there was complete ptosis on the left side and partial ptosis on the right side. There was no nystagmus. The left pupil was larger (5.5mm) than the right (3.5mm) and both pupils were non-reacting to light and accommodation. No afferent pupillary defect was present. Fundoscopy revealed no abnormality. Left eye movement was limited to abduction and intortion on attempted down gaze. The right eye was moving fully except in the direction of the superior rectus muscle. The rest of the neurological examination was also normal. Magnetic resonance imaging (MRI) of the brain revealed single ring enhancing lesion (11.6x9.7 x 11.11mm) with perifocal edema and the central part of the lesion containing fluid (hypointense on T1W1 and hyperintense on T2W2) at the tegmentum of the left midbrain [Figure - 1]. The rest of the brain parenchyma, ventricular system and subarachnoid space was normal. The biochemical and cytological examination of CSF revealed protein of 50mg%, sugar of 40mg%, and 9 cells, all lymphocytes. Polymerase chain reaction (PCR) analysis of mycobacterium DNA was negative both in CSF and serum. Enzyme-linked immunosorbent assay (ELISA) for cysticercus was positive both in CSF and serum. X-Ray chest, thigh and arm were normal. The patient was treated only with edema-lowering agents and he recovered in his symptoms on the sixth day. Follow-up CT scan at four months revealed complete resolution of the granuloma. At one-year follow-up, the patient was completely asymptomatic.

The case demonstrates that midbrain cysticercosis may present with recurrent episodes of unilateral or bilateral third cranial nerve affection.

Copyright 2004 - Neurology India

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