Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 2192  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  » Next article
  » Previous article 
  » Table of Contents
  
 Resource Links
  »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »Related articles
  »  Article in PDF (18 KB)
  »  Citation Manager
  »  Access Statistics
  »  Reader Comments
  »  Email Alert *
  »  Add to My List *
* Registration required (free)  


  In this Article
 »  Abstract
 »  Introduction
 »  Case Report
 »  Discussion
 »  References

 Article Access Statistics
    Viewed6722    
    Printed277    
    Emailed6    
    PDF Downloaded160    
    Comments [Add]    
    Cited by others 22    

Recommend this journal

   
CASE REPORT
Year : 2003  |  Volume : 51  |  Issue : 4  |  Page : 551-552

Neurocysticercosis presenting as Weber’s syndrome: As short report


Department of Neurology, BHU, Varanasi

Correspondence Address:
Department of Neurology, BHU, Varanas

  »  Abstract

This case report describes a rare, non-epileptic manifestation of neurocysticercosis where a 22-year-old male presented with acute onset right 3rd nerve palsy with left hemiplegia (Weber syndrome). Computerized tomography and magnetic resonance imaging revealed cysticercus granuloma. The patient improved and became asymptomatic with steroid treatment. Recognizing this clinical entity would avoid unnecessary antituberculous treatment and surgical intervention.

How to cite this article:
Singh N N, Verma R, Pankaj B K, Misra S. Neurocysticercosis presenting as Weber’s syndrome: As short report. Neurol India 2003;51:551-2


How to cite this URL:
Singh N N, Verma R, Pankaj B K, Misra S. Neurocysticercosis presenting as Weber’s syndrome: As short report. Neurol India [serial online] 2003 [cited 2019 Nov 14];51:551-2. Available from: http://www.neurologyindia.com/text.asp?2003/51/4/551/5041



  »   Introduction Top

Weber's syndrome is a distinctive brainstem syndrome characterized by ipsilateral 3rd nerve palsy with contralateral hemiplegia and is due to an intrinsic or extrinsic lesion in the ventral midbrain. The first case was described by Sir Herman David Weber, a London-based physician in the 19th century, and the eponym of the syndrome goes in his name.[1] Since then many cases of non-vascular causes including aneurysm, tumor and demyelination have been reported. We report a rare cause of Weber's syndrome, cysticercus granuloma.


  »   Case Report Top

A 25-year-old male presented with acute onset left side weakness. The following day he noticed diplopia while looking forward and drooping of the right eyelid. Drooping of the right eyelid was complete in the next two days. By then the patient had marked difficulty in walking and had to take the support of a stick. He had no features of raised intracranial tension. He was not hypertensive or diabetic and was a non-smoker. Neurological examination revealed a conscious individual with normal higher functions. Cranial examination revealed complete right 3rd nerve palsy and normal ocular fundi. Motor system showed left side spastic weakness with grade 4/5 power. Deep tendon reflexes were brisk on the left side with up-going plantar response. Sensory system examination was essentially normal. There were no cerebellar signs.
Contrast enhanced Computerized tomography (CT) scan revealed a small enhancing ring lesion on the right side of the midbrain. Contrast enhanced magnetic resonance imaging (MRI) revealed a small ring enhancing granuloma in the ventral midbrain over the right side with eccentric nidus (isointense) [Figure:1]. Enzyme-linked immunosorbant assay using purified fraction from taenia solium cysticerci (PCF-ELISA) in cerebrospinal fluid (CSF) showed a strong positive result.
The patient was treated with steroids for two weeks. The patient showed rapid clinical improvement in his hemiparesis, ptosis and ocular movements. Neurological examination at 2 months follow-up showed that he was symptom-free with no neurological deficit. Follow-up MRI revealed no abnormality.


  »   Discussion Top

The most common cause of Weber's syndrome is vascular and is due to the occlusion of the peduncular and interpeduncular branches of the posterior cerebral artery, often due to embolic occlusion.[2] Cysticercus granuloma as the cause of Weber's syndrome has not been recorded earlier. In our case contrast MRI and CT scan revealed characteristic granuloma with eccentric nidus suggestive of neurocysticercosis.[3] The other evidence was PCF-ELISA positivity in CSF. The remarkable clinical and radiological improvement with steroids also supports the diagnosis of a cysticercus.[4]
Vascular events are common manifestations of neurocysticercosis and neurocysticercosis is considered to be a risk factor for stroke in the young in endemic areas. Strokes are caused by the inflammatory occlusion of the arteries at the base of the brain, secondary to cysticercus arachnoiditis. Small vessels of the circle of Willis are usually involved presenting as lacunar stroke.
The granulomatous stage represents cysticercal cyst in the degenerative phase. The role of anticysticercal treatment in this stage is controversial.[5] Steroids may be effective in containing the inflammatory response in such a situation. 

  »   References Top

1.Liu CT, Cremer CW, Logigian EL, et al. Midbrain syndrome of Benedict, Claude, Nothnagel-setting record straight. Neurology 1992;42:1820-2.  Back to cited text no. 1    
2.Koroshetz WJ, Ropper AH. Artery to artery embolism causing stroke in posterior circulation. Neurology 1987;37:292-6.  Back to cited text no. 2    
3.Rajshekhar V, Chandy MJ. Validation of diagnostic criteria for solitary cerebral cysticercus granuloma in patient presenting with seizures. Acta Neuro Scand 1997;96:76-81.  Back to cited text no. 3  [PUBMED]  
4.DeSalva AD, Quagliato EM, Rossi CL. A quantitative enzyme linked immunosorbent assay (ELISA) for the immunodiagnosis of neurocysticercosis using purified fraction from taenia solium cysticerci. Diag Microbiol Inf Dis 2000;37:87-92.  Back to cited text no. 4    
5.Kramer LD. Medical treatment of cysticercosis - ineffective. Arch Neurol 1995;52:101-2.  Back to cited text no. 5    

 

Top
Print this article  Email this article
Previous article Next article
Online since 20th March '04
Published by Wolters Kluwer - Medknow