Isolated Orbital Myocysticercosis

Pooja Shadangi Saggar (M.B.B.S), Resident ,Okay Dagnostic and Research center , Jaipur.

Email;Pooja_shadangi@yahoo.co.in.

Vineet Saggar(,Mch Neurosurgery), Consultant Neurosurgeon IVY group of Hospitals ,

Mohali.E-mail; memymyselfus@yahoo.co.in..

R.S. Mittal, Professor and Head of Department Neurosurgery, S.M.S Medical College Jaipur.

• A 28 year old vegetarian male presented in out patient department with complaints of retro-orbital pain and swelling around right eye. He also had diplopia more pronounced on looking down towards left side

• Fig A FIG B Fig C

Legends of figures

FIG A FIG B FIG C

• Fig A: Coronal T1 weighted image showing cystic lesion in superior rectus muscle which is isointensewith hypointense nodule in its wall.

• Fig B: Saggital T 1 weighted image showing hypointense cystic lesion in belly of sup rectus muscle

• Fig C: Cyst is hyperintense on T-2 weighted images visible on coronal images

Diagnosis: Orbital Myocysticercosis• Cysticercosis is caused by larval form of Taenia Solium. The commonest pattern of

systemic involvement is seen as neurocysticercosis and appears as a space occupying intracranial lesion.

• Intraocular infections by Cysticercus cellulosae are more common compared to ocular adnexal involvement.The cysts may be located in descending order of frequency, subretinal (35%), vitreous(22%), conjunctiva (22%), anterior segment (5%) and orbit(1%)

• Clinical features: Signs and symptoms at presentation are periocular swelling , ptosis, ocular motility restriction , proptosis , and diplopia.

• MRI imaging is the best method of assessing patient and may confirm presence of coexistant neuro-cysticercosis . If routine sequences do not show the intraocular cyst clearly, a the high resolution CISS sequence may be used. Viable cysts show a hyperintense nodule and hypointense cystic fluid on T1-weighted images. On T2-weighted images the hypointense nodule is in contrast with the hyperintense fluid.

• D/D include orbital tumours , pseudotumours and other granulomatous inflamations of orbit

• T/T:Orbital adnexal disease in the absence of intraocular disease is treated medically, with Albendazole (15 mg/ kg-/day )along with oral prednisolone (1 to 1.5 mg /kg/day for 4 weeks) (fundus examinaiton to rule out intraocular disease is must before staring medical therapy). Intraocular disease generally requires surgical intervention.

Suggested Reading

• Isolated Cysticercal Infestation of ExtraocularMuscles: CT and MR Findings.Meher

A. Ursekar, Darab K. Dastur, Daya K. Manghani, and Atul T. Ursekar.Am J

Neuroradiol 19:109 –113, January 1998

• Suss RA, Maravilla KR, Thompson J. MR imaging of intracranial cysticercosis:

comparison with CT and anatomorphologic features. AJNR Am J Neuroradiol

1986;7:235–242