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|Year : 2017 | Volume
| Issue : 1 | Page : 221-222
Unilateral lateral rectus cysticercosis presenting as Duane retraction syndrome type IIb
Pratibha Prasad1, Prakash K Sinha2, Deepika Joshi2, Sandeep K Chaudhary2
1 Department of Neurology, Dr. S.N. Medical College, Jodhpur, Rajasthan, India
2 Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
|Date of Web Publication||12-Jan-2017|
Department of Neurology, Dr. S.N. Medical College, Jodhpur - 342 001, Rajasthan
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Prasad P, Sinha PK, Joshi D, Chaudhary SK. Unilateral lateral rectus cysticercosis presenting as Duane retraction syndrome type IIb. Neurol India 2017;65:221-2
Orbital cysticercosis is caused by the larval form of Taenia solium in the orbital cavity. It may involve intraocular or extraocular structures. As per the Indian literature, ocular involvement occurs in 1.8–4.5% cases only, the ocular adnexa being the preferred site. Despite the rarer involvement of extraocular muscle cysticercosis, Duane retraction syndrome as a presenting manifestation has never been reported. We report a case of a 17-year-old non-vegetarian male patient, a resident of Mau, Uttar Pradesh, who presented with gradually progressive binocular horizontal diplopia and redness of the left eye since 2 months without any diminution of vision, proptosis or pain during the eye movements. On examination, the left eye showed severe limitation of adduction, but had normal abduction. This was accompanied by pseudoptosis on adduction, which got corrected on attempted abduction. There was also exotropia in the primary gaze. These finding were suggestive of the Duane retraction syndrome type 2b [Figure 1]a. The routine investigations were within normal limit. Chest X-ray and urine microscopy were normal. The stool was negative for ova and cysts. Magnetic resonance imaging (MRI) with orbital images, on post-contrast T1-weighted images, showed a ring enhancing lesion (arrow) in the left lateral rectus muscle that was suggestive of cysticercosis [Figure 2]. The patient was put on oral prednisolone (1 mg/kg/day) for 4 weeks with the gradual tapering of the dose over the next 1month. After 2 months of regular follow-up, the patient showed partial improvement in the left eye's restriction of adduction. There was no ptosis seen [Figure 1]b. Computed tomographic scan done 6 months after the treatment showed no cystic lesion or nodule. No new lesion could be seen. Thus, we highlight an uncommon presentation of a very common disorder in our case where an early intervention avoided any delay in diagnosis and treatment.
|Figure 1: (a) Left eye showing severe limitation in adduction with normal abduction, with pseudoptosis on adduction, which was corrected on attempted abduction. There was exotropia in primary gaze. These findings were suggestive of Duane retraction syndrome type 2b. (b) Posttreatment status after 2 months showing partial improvement in left eye adduction limitation without the presence of any ptosis|
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|Figure 2: Magnetic resonance imaging with orbital cuts post-contrast T2-weighted images showing a ring enhancing lesion in the left lateral rectus muscle, suggestive of cysticercosis (grey arrow)|
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| » References|| |
Wadia NH, Singh G. Neuro-cysticercosis. Neurological Practice: An Indian Perspective; 2005.p. 215-51.
Pandey PK, Choudhry Z, Sharma P, Bhomaj S. Extraocular muscle cysticercosis: A Clinical masquerade. J Pediatr Ophthalmol Strabismus 2000;37:273-8.
[Figure 1], [Figure 2]