A case of neurocysticercosis presenting as oculomotor nerve palsy

Abstract : Cysticercosis is a parasitic infestation that results from ingestion of eggs of adult tapeworm, Taenia solium. When cysticercosis involves the central nervous system, it is called neurocysticercosis. Neurocysticercosis is the most common parasitic infestation of the brain and a leading cause of epilepsy in the developing world, especially Latin America, India, Africa, and China. In this case,16 year old male presented with complaints of sudden onset diplopia and drooping of left upper eyelid of one month duration. Evaluation of the patient revealed complete oculomotor nerve palsy on the left side. Patient was admitted with complaints of altered sensorium and ventriculo-peritonal shunt done for dilatation of all ventricles one year before. He was emprically given anti tuberculous treatment . All investigations were normal including cerebrospinal fluid analysis on previous admission. Now the MRI brain showed multiple ring enhancing lesions at thalamus, midbrain and corpus callosum. MRI Spectroscopy showed elevated levels of lactate with in the lesions suggestive of neurocysticercosis. Isolated oculomotor nerve palsy is a very rare manifestation of neurocysticercosis.