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MRI In Intraocular Cysticercosis - A Case Report

IBS NIJJAR, JP SINGH, V ARORA, R ABROL, PS SANDHU, R CHOPRA, ROOPA

Ind J Radiol Imag 2005 15:3:309-310

Keywords: Cysticercosis, Intraocular, MRI.

I
nfection with member of the Taenia tapeworm
genus represents an important etiology of parasitic
ocular disease. Taenia solium (along with its larval form,
cysticercosis cellulosae) is the most-common species
causing cysticercosis in humans.

Taxonomically, taeniasis (infection by the adult worm)

must be differentiated from the cysticercosis (infection
by the larvae). However, patients may harbor both
taeniasis and cysticercosis. Taeniasis is an intestinal
infection caused by consumption of the adult worm through
undercooked pork and is not associated with ocular
disease. In cysticercosis, the humans act as an
intermediate host following the consumption of eggs in
contaminated food or water. After ingestion, the eggs hatch
and mature to larvae, which are carried by mesenteric
vessels to various parts of the body, where they are filtered
through subcutaneous and intramuscular tissues, with
preference for the brain and eyes (1). Ocular disease is
reported to occur in a significant number of cases of
cysticercosis (2).

We would like to report a case of a solitary intraocular

cysticercosis diagnosed on MRI.

There was no evidence of neurocysticercosis.

Fig. 2 - CISS sequence clearly showing sub-retinal cyst with

scolexA in the right eyeball
(a) Axial plane.
(b) sagittal plane.
Fig. 1 - TSE T2W axial scan showing retinal detachment (c) coronal plane.
with suspicion of a sub-retinal lesion postero-laterally in the
right eyeball.

From the Nijjar Scan & Diagnostic Centre, Amritsar

Request for Reprints: Dr. Inder Bir Singh Nijjar, Nijjar Scan & Diagnostic Centre, Amritsar

Received 24 July 2004 ; Accepted 10 March 2005

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310 IBS Nijjar et al
CASE REPORT:
A twenty six year old man presenting with blurring of vision
in the right eye for ten days was referred for MRI of the
brain by a general practitioner. There was no history of
trauma, hypertension, diabetes or neurological deficit.
Routine MRI of the brain on 1.5 Tesla scanner (Magnetom
Symphony: Siemens) was normal. However, axial TSE
T2W (5mm slice thickness with 4mm table feed) revealed
retinal detachment with suspicion of a tiny lesion in the
postero- lateral quadrant of the right eyeball (fig.1). TSE
T2 W AND SE T1 W sequences in coronal and sagittal
planes were uninformative. A high resolution CISS
(constructive interference in steady state) sequence was
performed in axial plane with reconstruction in the sagittal
and coronal planes. A well-defined, thin walled cyst was
observed along the postero-lateral wall of the right
orbit. It measured 0.6 x 0.5cm in size. A tiny eccentric
hypointense speck was seen in it suggestive of scolex
(fig. 2a, b &c).
A diagnosis of intraocular cysticercosis with retinal
detachment was made. The patient underwent surgery
and the cyst was sucked out. It was intravitreal in location
with inflammation in the surrounding tissues. The patient
was asymptomatic after surgery.
DISCUSSION:
The unique structure of the human eye as well as exposure
of the eye directly to the environment renders it vulnerable
to a number of uncommon infectious diseases caused
by fungi and parasites. Host defenses directed against
these microorganisms, once anatomical barriers are
breached, are often insufficient to prevent loss of vision.
Therefore, the timely identification and treatment of the
involved microorganisms are paramount(1).
Most parasitic infections of the eye arise following blood
borne carriage of the microorganism to the eye or adjacent
structures (1). The extra-ocular muscle forms the most
common type of orbital cysticercosis(3). In the ocular
form, the favoured sites are the vitreous and the subretinal
space(4). Of 520 cases described by kruger-leite et al.,
35 percent were subretinal, 22 percent vitreal cavity, 72
percent retinal and vitreal, 22 percent subconjuctival. In
only 5 percent of case were parasites seen in the anterior
chamber (5). Symptoms may include periorbital pain,
diplopia, ptosis, blurring or loss of vision, distortion of
images, and the sensation of light flashes (1).
IJRI, 15:3, August 2005
Diagnosis of ocular cysticercosis is usually accomplished
by direct ophthalamoscopic demonstration of the larval
worm. Ultrasound, CT and MRI are other modalities for
establishing the diagnosis. MR is however the best tool
for intraocular as well as neuro-cysticercosis.
Medical treatment is known to cause severe ocular
complications, which may lead to loss of the eye (6).
Hence, the importance of early diagnosis of intraocular
cysticercosis.
Routine sequences did not show the intraocular cyst as
clearly as the high resolution CISS sequence. A high
degree of suspicion and use of correct sequence with
thin slices Is highlighted here.
BIBLIOGRAPHY :-
1) Stephen A. Klotz , Christopher C. Penn, Gerald J.
Negvesky and Salim I. Butrus. Fungal and parasitic
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2) Garcia, L., and D. Bruckner . 1997. Diagnostic medical
parasitology. 3rd ed. ASM press, Wahington, DC.
3) S. K. Sethi, U. Hemal, R. S. Solanki, and A. Bhagra. Orbital
Cysticercosis. Ind J Radiol Imag 2004 14:1:93-94.
4) Pushker N, Bajaj MS, Chandra M, Neena. Ocular and
orbital cysticercosis. Acta ophthalmol Scand 2001;79:
408-413.
5) Kruger-Leite, E., Jalkh, A.E., Quiroz, H., and Schepens,
C.L. (1985). Intraocular cysticercosis. American Journal
of Ophthalmology, 99, 252-7.
6) Krishna M. Rao, Subhash V. Vargiya, and Neera Kohli.
Rapid onset unilateral vision loss by intra-ocular
cysticercosis-Demonstrated by MRI. Ind J Radiol
Imag1999; 9: 3.