Neuro-ocular cysticercosis causing total retinal detachment and cataract.

Sir,

A 14-year-old boy presented with headache, diminution of vision in the left eye, and one episode of seizure. Magnetic resonance imaging (MRI) of the brain revealed multiple tiny T2-weighted (T2W) hypointense lesions along with few small cystic lesions in bilateral cerebral hemispheres [Figure 1a]. A small cystic lesion was also seen in the right perimesencephalic cistern [Figure 1a]. Some of the cerebral lesions showed presence of mild perilesional edema. A tiny T2W hypointense lesion was also seen along the retina on the left side [Figure 1b]. In addition, presence of a “V-shaped” membranous structure within the left eyeball suggested retinal detachment [Figure 1c]. The left ocular lens revealed abnormal hyperintense signal on T2W images, which raised a suspicion of lens opacification [Figure 1d]. Computed tomography (CT) scan showed a typical “starry sky” appearance due to tiny calcified granulomas in both cerebral hemispheres [Figure 2a]. The left retinal lesion also revealed a tiny calcific speck [Figure 2b]. A diagnosis of neurocysticercosis with left ocular cysticercosis was made based on the imaging findings. Slit lamp examination of the left eye revealed a complicated cataract. Dilated fundal examination of the left eye showed complete retinal detachment with presence of a cysticercous granuloma along the retina. The patient underwent surgery for the removal of the left ocular cysticercous granuloma and correction of the retinal detachment and cataract. Postsurgical period was uneventful. Oral albendazole therapy with steroid was commenced after surgery.

Figure 1

(a) The T2-weighted (T2W) magnetic resonance imaging (MRI) axial image of brain reveals multiple tiny hypointense lesions with few cystic lesions in bilateral cerebral hemispheres. A small cystic lesion is also noted in right perimesencephalic cistern. (b) Small hypointense lesion is seen along the retina of left eyeball on T2W coronal image. (c) A “V-shaped” membranous structure is seen within the left eyeball on T2W axial image suggestive of retinal detachment. (d) Abnormal T2W hyperintense signal is seen in the left ocular lens due to cataract formation

Figure 2

(a) Computed tomography (CT) scan reveals multiple tiny calcific foci (“starry sky” appearance) suggestive of calcified cysticercus scolices. (b) A tiny calcific speck seen along the retina of left eyeball is suggestive of calcified cysticercus scolex

The brain and eye are the classical sites of involvement for cysticercosis. Death of the cysticercus cyst results in release of toxic products which incites inflammation in the surrounding tissues.[1] Such inflammatory response in the eye may cause exudative retinal detachment, retinal hemorrhages, proliferative vitreoretinopathy, uveitis, and even cataract formation.[2] CT and MRI are excellent modalities for diagnosing central nervous system (CNS) and ocular cysticercosis. Though ultrasonography is the standard modality for imaging evaluation of the eyeball, we were able to detect specific findings such as retinal detachment and retinal cysticercus granuloma on MRI. In addition to detecting the cysticercus lesions in brain, all the ophthalmic abnormalities were correctly detected by MRI and later confirmed by opthalmoscopic examination.