Suprasellar Cysticercosis Cyst with Optic Nerve Compression Masquerading as an Arachnoid Cyst.

Cysticercosis is a parasitic infection caused by the larvae of the cestode Taenia solium. Ocular parasitosis in humans is well recognized; however, cysticercosis of the optic nerve is rare. Here, we report a case of an adult male who presented with right-sided headache and a gradual loss of vision in the right eye. Optical coherence tomography indicated severe loss of ganglion cells in the right eye. Magnetic resonance imaging showed a predominantly suprasellar cystic lesion thought to represent an arachnoid cyst. We performed a craniotomy to excise the cyst. Histopathological examination of the excised cyst revealed internal living larvae of T. soilum. After co-administration of praziquantel and albendazole, vision was restored, and the headaches ceased. Vision has since been restored in both eyes. A higher degree of neurocysticercosis suspicion should be maintained for patients living in endemic areas who present with ophthalmic symptoms where the brain scans show cystic lesions.

Optic nerve involvement in ocular toxoplasmosis: 12 year data from a tertiary referral center in Turkey / Acometimento de nervo óptico na toxoplasmose ocular: um relato de 12 anos de um centro de referência terciário na Turquia

ABSTRACT Purpose: To evaluate the prevalence, clinical characteristics, and types of optic nerve involvement in patients with ocular toxoplasmosis. Methods: For this retrospective cross-sectional study, we examined all patients with active ocular toxoplasmosis referred to our Uveitis Section during the last 12 years, and we included patients with optic nerve involvement in the study. The primary outcome was the prevalence of optic nerve involvement, and secondary outcomes included the types of optic nerve involvement and the final best-corrected visual acuity after treatment. Results: The prevalence of optic nerve involvement was 14.4%, with the leading cause being the activation of a juxtapapillary lesion (70.5%). We found papillitis in two eyes and neuroretinitis in two eyes (11.7% for each). We only detected one optic nerve involvement secondary to a distant active lesion (5.8%). Sixteen patients (94.1%) had unilateral ocular toxoplasmosis. The overall final best-corrected visual acuity after treatment was 10/10 (LogMAR = 0.0) excluding the three patients with a juxtapapillary scar involving the macula. Conclusions: Optic nerve involvement was common in patients with ocular toxoplasmosis. The main type of optic nerve involvement was caused by activation of an old juxtapapillary lesion. Treatment was quickly effective, but the best-corrected visual acuity was dependent on the presence of a scar in the papillomacular bundle.

RESUMO Objetivos: Avaliar a prevalência, características clínicas e tipos de acometimento do nervo óptico em pacientes com toxoplasmose ocular. Métodos: Para este estudo retrospectivo transversal, examinamos todos os pacientes com toxoplasmose ocular ativa encaminhados ao nosso Setor de Uveíte nos últimos 12 anos, e incluímos pacientes com comprometimento do nervo óptico no estudo. O resultado primário foi a prevalência do envolvimento do nervo óptico, e os resultados secundários incluíram os tipos de envolvimento do nervo óptico e a acuidade visual final melhor corrigida após o tratamento. Resultados: A prevalência de acometimento do nervo óptico foi 14,4%, sendo a principal causa a ativação de uma lesão justapapilar (70,5%). Encontramos papilite em dois olhos e neuroretinite em dois olhos (11,7% para cada um). Apenas detectamos um comprometimento do nervo óptico secundário a uma lesão ativa distante (5,8%). Dezesseis pacientes (94,1%) apresentavam toxoplasmose ocular unilateral. A acuidade visual final com melhor correção após o tratamento foi 10/10 (LogMAR= 0,0) excluindo os três pacientes com uma cicatriz justapapilar envolvendo a mácula. Conclusões: O comprometimento do nervo óptico foi comum em pacientes com toxoplasmose ocular. O principal tipo de comprometimento do nervo óptico foi causado pela ativação de uma lesão justapapilar antiga. O tratamento foi rapidamente eficaz, mas a acuidade visual final com melhor correção foi dependente da presença de uma cicatriz no feixe papilomacular.

Optic nerve involvement in ocular toxoplasmosis: 12 year data from a tertiary referral center in Turkey.

PURPOSE: To evaluate the prevalence, clinical characteristics, and types of optic nerve involvement in patients with ocular toxoplasmosis. METHODS: For this retrospective cross-sectional study, we examined all patients with active ocular toxoplasmosis referred to our Uveitis Section during the last 12 years, and we included patients with optic nerve involvement in the study. The primary outcome was the prevalence of optic nerve involvement, and secondary outcomes included the types of optic nerve involvement and the final best-corrected visual acuity after treatment. RESULTS: The prevalence of optic nerve involvement was 14.4%, with the leading cause being the activation of a juxtapapillary lesion (70.5%). We found papillitis in two eyes and neuroretinitis in two eyes (11.7% for each). We only detected one optic nerve involvement secondary to a distant active lesion (5.8%). Sixteen patients (94.1%) had unilateral ocular toxoplasmosis. The overall final best-corrected visual acuity after treatment was 10/10 (LogMAR = 0.0) excluding the three patients with a juxtapapillary scar involving the macula. CONCLUSIONS: Optic nerve involvement was common in patients with ocular toxoplasmosis. The main type of optic nerve involvement was caused by activation of an old juxtapapillary lesion. Treatment was quickly effective, but the best-corrected visual acuity was dependent on the presence of a scar in the papillomacular bundle.

Orbital apex syndrome secondary to optic nerve cysticercosis.

A 22-year-old male presented to us with complaints of sudden painful loss of vision in left eye 10 days ago along with inward deviation of the left eye. Best-corrected visual acuity (BCVA) in right eye was 20/20 and 20/50 in left eye. Left eye showed limitation of abduction, a relative afferent pupillary defect, normal anterior segment with optic disc oedema. Contrast-enhanced MRI of the brain and orbit showed thickening of left optic nerve along with a cystic lesion near the orbital apex with a central iso- to hyperintense spot resembling a scolex. A diagnosis of left orbital apex syndrome secondary to optic nerve cysticercosis was made. Patient was treated with oral albendazole and intravenous corticosteroids for 3 days followed by oral corticosteroids. Ten weeks post-treatment, his BCVA in the left eye improved to 20/20 and colour vision and visual fields improved. Pallor of the left optic disc was noted, and ocular motility improved completely. MRI after treatment showed a decreased thickness of left optic nerve with disappearance of the cystic lesion.

Toxoplasmosis ocular. Descripción de tres pacientes con presentación atípica / Ocular toxoplasmosis. Description of three patients with an atypical presentation.

Objetivo: Describir una forma de presentación atípica de toxoplasmosis ocular, enfatizando la importancia de la jerarquización de los hallazgos clínicos y las limitaciones de la serología para realizar un diagnóstico temprano. Pacientes y Métodos: Estudio retrospectivo y descriptivo de tres casos clínicos de toxoplasmosis ocular activa, con presentación atípica (compromiso del nervio óptico), derivados al Servicio de Oftalmología del Hospital J. P. Garrahan en el periodo comprendido entre 2007 y 2010. Resultados: En los tres casos presentados la sospecha clínica de toxoplasmosis ocular no se correlacionó con evidencia serológica de infección reciente. En un caso, la terapéutica específica temprana, basada en la sospecha clínica, resultó en una excelente recuperación funcional. Un tratamiento tardío puede interferir en el resultado visual. Conclusiones: Basados en los hallazgos clínicos y la alta sospecha de esta patología debe iniciarse el tratamiento específico sin esperar que los resultados serológicos la confirmen. Eventualmente, la mejoría clínica confirmara el diagnóstico. El comportamiento de los títulos de anticuerpos en el curso de la enfermedad ocular no siempre es confiable, y en muchos casos retrasa el comienzo de la terapéutica con la consiguiente mala rehabilitación visual de estos pacientes (AU)

Objective: To describe an atypical presentation of ocular toxoplasmosis, emphasizing the importance of clinical findings and the limitations of serology in the early diagnosis. Patients and Methods: A retrospective, descriptive study was conducted of three cases with active ocular toxoplasmosis with an atypical presentation (optic nerve involvement), referred to the Department of Ophthalmology of Hospital J. P. Garrahan between 2007 and 2010. Results: In the three cases presented here clinical suspicion of ocular toxoplasmosis did not correlate with serological evidence of a recent infection. In one case, early treatment, based on clinical suspicion, resulted in excellent functional recovery. Late management may compromise visual outcome. Conclusions: Based on clinical findings and suspicion of the pathology, specific treatment should be started without waiting for serological confirmation. Eventually, clinical improvement will confirm the diagnosis. The behavior of antibody titres in the course of the ocular disease is not always reliable and often delays treatment initiation with subsequent difficulties in the visual rehabilitation of these patients (AU)

In the eye of experimental cerebral malaria.

Cerebral malaria is the most severe complication of Plasmodium falciparum infection, accounting for 1 million deaths per year. We characterized the murine disease using in vivo magnetic resonance imaging (MRI) at 4.7 T, proving that ischemic edema is responsible for fatality. The aim of the present study was to identify early markers of experimental cerebral malaria using very high field conventional MRI (11.75 T). CBA/J mice infected with Plasmodium berghei ANKA were observed at an early stage of the disease, before the onset of detectable brain swelling and at the most acute stage of cerebral malaria. Herein, we report the first detection of damage to the optic and trigeminal nerves on T(2)-weighted MRI. The trigeminal nerves appeared hypointense, with significantly reduced diameter and cross-sectional area. The optic nerves were hypointense and often not visible. In addition, the internerve distance between the optic nerves was significantly and progressively reduced between the early and severest stages. Cranial nerve injury was the earliest anatomic hallmark of the disease, visible before brain edema became detectable. Thus, cranial nerve damage may manifest in neurologic signs, which may assist in the early recognition of cerebral malaria.

Clinical manifestations of ocular toxoplasmosis.

Clinical manifestations of ocular toxoplasmosis are reviewed. Findings of congenital and acute acquired ocular toxoplasmosis include retinal scars, white-appearing lesions in the active phase often associated with vitritis. Complications can include fibrous bands, secondary serous or rhegmatogenous retinal detachments, optic neuritis and neuropathy, cataracts, increased intraocular pressure during active infection, and choroidal neovascular membranes. Recurrences in untreated congenital toxoplasmosis occur in teenage years. Manifestations at birth are less severe, and recurrences are fewer in those who were treated promptly early in the course of their disease in utero and in the first year of life. Severe retinal involvement is common at diagnosis of symptomatic congenital toxoplasmosis in the United States and Brazil. Acute acquired infections also may be complicated by toxoplasmic retinochoroiditis, with recurrences most common close to the time of acquisition. Suppressive treatment can reduce recurrent disease.

Utility and effectiveness of computerised motion sensitivity screening tests in rural onchocercal community survey.

BACKGROUND: Non-invasive tool of community diagnosis for onchocercal endemicity needs to be identified and ascertained for their utility and effectivity in order to facilitate the control of onchocerciacis in sub-Saharan Africa OBJECTIVE: To determine the utility and effectiveness of the Wu-Jones Motion Sensitivity Screening Test (MSST) in detecting optic nerve diseases in onchocercal-endemic rural Africa. METHODS: MSST was applied to sampled subjects in the selected communities of Raja in Sudan; Bushenyi in Uganda; Morogoro in Tanzania; and of Ikom, Olamaboro and Gashaka in Nigeria. Basically, six points within the central field of vision were repeatedly tested at 1/3 meter from the screen of a laptop computer in a room darkened. Motion sensitivity was expressed as a percentage of motion detected in the individual eye and this was averaged for the community. RESULTS: A total of 3,858 eyes of 2,072 patients were examined. Seventy-six percent of the subjects completed the test, at an average test time of 120.4 (66.7) seconds. The overall mean motion sensitivity of all eyes tested was 88.49 (17.49%). At a cut-off point of 50%, 6.4% of all subjects tested were subnormal, while at 70% cutoff, 13.3% were subnormal. The highest proportion of 50% cutoff sub-normality was recorded at Morogoro at 12.7%. CONCLUSION: Motion Sensitivity Screening Test was widely accepted and easily administered to the rural and largely illiterate subjects studied. Our data suggest that the proportion of severe field defects by MSST in a community, with cutoff at 33%, best correlates with optic nerve disease prevalence, while proportion of defect from a higher cut-off level at about 50%, best correlates with overall ocular morbidity.

Retrobulbar cysticercosis masquerading as optic nerve glioma.

Extra ocular muscles are the most common site of involvement in orbital cysticercosis. We present a case of retrobulbar cysticercosis masquerading clinically as optic nerve glioma.

Optic nerve changes in ocular toxoplasmosis.

PURPOSE: To determine the prevalence and features of the different types of involvement of the optic nerve in ocular toxoplasmosis. METHODS: Retrospective cross-sectional study. All patients with active ocular toxoplasmosis, consulting in the Uveitis Section of the Ophthalmology Department were selected. The involvement of the optic nerve was classified in the following categories: juxtapapillary retinochoroiditis, pure papillitis, neuroretinitis, distant lesion, and mixed lesion. RESULTS: The prevalence of involvement of the optic nerve found was 5.3%. The optic nerve involvement with the presence of a concurrent active distant lesion, occurred in 22 eyes (43.1%). A juxtapapillary lesion was found in 18 eyes (35.3%). Eight eyes (15.7%) presented lesions characterised as mixed. Isolated papillitis occurred in 3 eyes (5.9%). Forty-seven lesions (95.9%) were unilateral and two (4.1%) were bilateral. Twenty-eight eyes (54.9%) had pre-existing lesions and 23 (45%) were primary lesions. Visual acuity improved in 35 eyes (71.4%) and remained unchanged in 14 eyes (28.5%). CONCLUSION: The involvement of the optic nerve most frequently found in ocular toxoplasmosis was optic nerve oedema with a concurrent distant active lesion. The second type of lesion most often found was juxtapapillary retinochoroiditis. Involvement was monocular in most cases and the visual prognosis was favourable.

Optic nerve cysticercosis.

Optic nerve cysticercosis is rare but causes significant visual morbidity. A high index of suspicion is warranted for patients in endemic areas who present with sudden vision loss. Visual morbidity can be prevented by early imaging studies and therapeutic interventions.

Optic nerve cysticercosis.

Cysticercosis of the optic nerve is an extremely rare entity and only seven cases have been reported in the world literature. A case of optic nerve cysticercosis in a 25-year-old woman is reported, along with a review of literature. The patient presented with two episodes of pain, diminution of vision and proptosis. Computed tomography and ultrasonography revealed an intraneural cyst with scolex in the retrobulbar portion of the optic nerve. A positive enzyme-linked immunosorbent assay test for cysticercosis further confirmed the diagnosis. Medical therapy in the form of oral albendazole and steroids resulted in complete resolution of the cyst, with few visual sequelae.

Presumed toxoplasmosic anterior optic neuropathy.

PURPOSE: To describe the clinical findings and course of toxoplasmic anterior optic neuropathy and to differentiate primary and secondary involvement. METHODS: Retrospective observational case series from a tertiary referral institution. Clinical and photographic charts of 13 patients with toxoplasmosis with direct optic nerve head involvement were reviewed and data were collected throughout the length of follow-up. RESULTS: Toxoplasmic anterior optic neuropathy was divided into two types. Type I was defined as secondary infectious involvement of the optic nerve head from an adjacent focus of chorioretinitis that resolved with chorioretinal scarring. Type II was defined as primary involvement of the optic nerve head that resolved without chorioretinal scarring. Visual acuity improved after treatment in both Type I and Type II patients; however, the visual prognosis was worse in Type I patients due to macular involvement. Eighty-three percent of Type II patients had a final visual acuity equal to or better than 20/25 compared to 50% of Type I patients. Visual field defects were present in all patients, most frequently arcuate or altitudinal (62%). Delay in diagnosis was common (54%), especially in Type II patients (71%). Vitreous inflammation was absent on the initial examination in 31% of the patients. CONCLUSION: Toxoplasmic anterior optic neuropathy is an uncommon manifestation of ocular toxoplasmosis. Delays in diagnosis are common because of the frequent lack of typical chorioretinitis or vitreous inflammation. Adjacent macular involvement strongly influences visual outcome.

Optic nerve cysticercosis: imaging findings.

We present the imaging findings of retrobulbar optic nerve cysticercosis in a 50-year-old woman with a 6-month history of vision loss. Contrast-enhanced CT revealed an approximately 7-mm ring-enhancing cyst with a mural nodule located in the anterior portion of the left optic nerve. A contrast-enhanced MR imaging study revealed a cystic lesion with peripheral enhancement of the mural nodule. Sonography showed a cystic mass with a focal area of increased echogenicity corresponding to the mural nodule.

Optic nerve cysticercosis in the optic canal.

The authors present a first case of cysticercosis in the optic canal in a fifteen-year-old female patient. Cysticercosis of the optic nerve is rare. A cyst in the optic canal, beneath the sheath of the optic nerve, has never been reported. The patient presented with rapidly diminishing vision in the left eye, headache and papillitis. A magnetic resonance imaging revealed a cystic lesion at the entrance of the optic canal. Surgery performed was a transcranial orbitotomy which included deroofing of the optic canal and removal of the cyst from under the sheath of the optic nerve. The cyst proved to be cysticercus histopathologically. The outcome was a remarkable visual recovery.

Establishing a reliable visual function test and applying it to screening optic nerve disease in onchocercal communities.

The computer Controlled Video Perimetry (CCVP) is a computer screening test for detecting visual function loss caused by onchocerciasis, glaucoma, etc. Installed on portable computers, the CCVP has been shown to be high acceptability in field community investigation. However, it is regarded to be difficult in obtaining reliable results from portable computer screening tests because of human behavioural variants and the lack of standard testing environment. In this paper, we propose an architecture for implementing a more reliable CCVP system. In particular, a self-organising neural network is applied to manage measurement noise caused by behavioural factors. A control unit is introduced to manage the overall behaviour of the system. The integrated test system has been used to screen optic nerve disease in onchocercal communities of rural Nigeria and the experimental results obtained from a large number of test records are very encouraging: reliable results from volatile test environments may be obtained using the proposed method.

Red-dot card test of the paracentral field as a screening test for optic nerve disease in onchocerciasis.

A new screening test for optic nerve pathology is described, consisting of a series of four red targets presented at an angle of 12 degrees in the paracentral field above and below the horizontal meridian. Nonperception and desaturation of the targets are recorded. Inter-observer variability studies found a kappa value = 0.8. A total of 6831 individuals aged > or = 5 years in communities that were mesoendemic for savanna onchocerciasis in Kaduna State, northern Nigeria, were screened using the test. Of the participants 22% were unable to complete the test; almost two-thirds of these (62%) were aged 5-8 years. After exclusion of those visually impaired or blind according to WHO criteria and those unable to complete the test, the test showed a sensitivity of 40% and a specificity of 98% for optic nerve disease when inability to visualize one or more targets was used as the definition of test failure. The sensitivity increased to 54% with a specificity of 96% when the criterion for failure included desaturation of one or more targets. These values compare favourably with those for other available screening methods. The test took 1-2 minutes to perform and was readily accepted by patients and nurses.