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Orbital cysticercosis is a rare condition. We report here 3 cases with orbital cysticercosis who presented with proptosis and ptosis (Case no. 1 and 2) and focal seizures (Case no. 3). All of them had a vision of 6/6. Diagnosis of cysticercosis was made on CT Scan. The lesions isolated in Cases 1 and 2 and were excised. Drug therapy was given to treat any persisting infestation. Case no 3 had multiple brain cysticerci in addition to the orbital one. However, the patient was lost to follow-up.
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PMID:Orbital cysticercosis. 130 95

Six cases of adnexal cysticercosis, (1 in the lacrimal gland, 3 orbital, and 2 palpebral) have been reported. In the lacrimal gland it presented as a painless, translucent cyst which closely simulated a simple dacryops. In the orbit, two of the cases presented as an acute abscess in the upper and inner quadrant. However, one of them initially presented and existed as a case of simple ptosis for a period of 8 months. The third orbital case appeared as a painless cyst in the upper and outer quadrant. In the lid the larva presented as a subcutaneous nodule in one case and in the other it was lodged in the orbicularis oculi muscle. The cyst was surgically removed in all cases and the diagnosis was confirmed by histopathological examination. Lodgement of cysticercus cyst in the lacrimal gland and in the orbicularis oculi muscle is reported for the first time.
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PMID:Cysticercus cellulosae in the lacrimal gland, orbit, and eye lid. 740 62

Metastasis to the orbital soft tissues is relatively uncommon. We report a rare case of renal cell carcinoma with orbital metastasis as the first clinical manifestation. A 48-year-old-man presented with left proptosis and complete ptosis of three weeks duration. Radiological examination revealed a left intraconal heterogeneous cyst-like lesion with rim enhancement immediately deep to the left superior rectus muscle. Diagnosed as having orbital cysticercosis, he was prescribed oral albendazole and prednisolone. But there was no clinical improvement. An incisional biopsy performed showed metastatic poorly differentiated carcinoma. The patient complained of backache and weight loss in the interim. Magnetic resonance imaging (MRI) of the spine showed extensive vertebral metastasis to the thoracic and lumbosacral spine and the iliac bone, with an incidental detection of a large mass from the right kidney. Further MRI of abdomen and chest showed a large right renal mass presumed to be a renal cell carcinoma with extension into the right renal vein, intra-abdominal lymph nodes, and peritoneum. There were small nodules in the lung suggesting the possibility of pulmonary metastatic deposits. Renal cell carcinoma does not respond to chemotherapy, immunotherapy, or radiation; because of the disease's advanced stage, the patient received palliative treatment. There have been only two other reports in the literature of metastatic renal cell carcinoma in the orbit where the proptosis was the initial presenting feature similar to our case.
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PMID:Orbital metastasis of renal cell carcinoma masquerading as cysticercosis. 1883 35

A nine-year-old girl presented with pain, unilateral ptosis, inflammation of the upper eyelid and restricted ocular motility. She was diagnosed to have ocular cysticercosis by magnetic resonance imaging of the orbit, which showed a well-defined ring-enhancing lesion in the superior rectus muscle of the left eye. Enzyme-linked immunosorbent assay for serum antibodies against cysticercus was positive. The patient improved dramatically on a therapeutic trial of albendazole and oral steroids. There was a history of spontaneous extrusion of the cyst five days after starting therapy. The conjunctival defect healed without any surgical intervention.
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PMID:Ocular cysticercosis: an unusual cause of ptosis. 2035 61

Cysticercosis is the most common parasitic disease of the nervous system. The disease occurs when humans become the intermediate host in the life cycle of Taenia solium by ingesting its eggs from contaminated food. The most common sites of involvement of cysticerci are soft tissue, eye and central nervous system. Unusual location of the cysts may result in uncommon manifestations. Ocular cysticercosis can involve both the intraocular and extra ocular muscle. Extra ocular muscle cysticercosis is rare. We are reporting the unusual manifestation of ptosis, proptosis, diminution of vision and medial rectus palsy due to cysticercosis. The patient was successfully treated with systemic steroids and albendazole.
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PMID:Unusual presentation of orbital cysticercosis-ptosis, diminution of vision and medial rectus weakness: a case report. 1991 4

Fluctuating ptosis is usually caused by Myasthenia gravis. There are a few case reports of central causes of fluctuating ptosis. A 58-year-old man presented with fluctuating ptosis of one year duration. He was diagnosed as having ocular myasthenia and investigated. On evaluation, his electrophysiological tests revealed negative decremental response and results of neostigmine test was negative. During follow-up, patient developed headache. Imaging of the brain revealed midbrain cysticercosis granuloma. The focal encephalitis and edema was responsible for fluctuating ptosis. It is therefore essential to be aware of conditions that cause such pseudomyasthenic features. Patients with ptosis need to be evaluated for other rare central cause especially when neostigmine test is negative.
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PMID:Cysticercosis of midbrain presenting with fluctuating ptosis. 2202 38

We report an atypical case of cysticercosis of the left levator-superior rectus complex, mimicking a painful partial third nerve palsy. The patient presented with painful diplopia, with limitation of elevation, depression and adduction of the left eye, associated with a ptosis of the upper left eyelid. Magnetic resonance imaging revealed two cysts, located within the left levator-superior rectus complex, and nine parenchymal cysts located in both hemispheres of the brain. Antibody titers directed against Cysticercus cellulosae were elevated as confirmed by Elisa and Immunoblot. Diplopia and local inflammation resolved after albendazole and systemic steroid treatment. Surgical resection of the cysts was unnecessary.
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PMID:[Orbital cysticercosis mimicking a painful third nerve palsy]. 2409 5

An 8-year-old girl presented to the neurology department with a complaint of insidious onset of left-sided ptosis and restricted elevation of the left eye. A CT scan orbit and brain revealed a ring-enhancing lesion in the levator palpebral superioris (LPS) and superior rectus (SR) muscle complex of the left eye and left parietal and right temporal region. She was started on steroid, followed by albendazole with improvement. The LPS/SR complex is the least common site of involvement among extraocular muscles in ocular cysticercosis. Specially, with brain neurocysticercosis (NCC), it is extremely rare. We report an unusual association of multiple brain NCC with ocular cysticercosis involving LPS and SR muscle.
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PMID:Multiple brain parenchymal neurocysticercosis with extraocular muscle cysticercosis affecting levator palpebral superioris and superior rectus complex: an unusual association. 2335 67

We are sharing a case of orbital cysticercosis,which presented to us initially with simple ptosis and later on with upper lid inflammation and restricted ocular motility in upgaze. Human cysticercosis, a parasitic infection caused by Cysticercus cellulosae, the larval form of the cestode, Taenia solium, is a benign infection of the subcutaneous tissues, inter-muscular fascia, muscles and other organs. Though it exists worldwide, it is more prevalent in the developing countries of Latin America, Asia and Africa, especially in areas where under-cooked pork is consumed regularly (Pushker et al, 2001). However, 5 year study of 33 cases of Ocular/Adnexal cysticercosis showed seventy percent of patients were of low socioeconomic group and 70% were strictly vegetarians (Atul et al, 1995). The clinical manifestation of orbital cysticercosis is entirely different from neuro-cysticercosis or cysticercosis of other parts of body. Diagnosis of cysticercosis is mainly based on highly specific radiological signs and history of exposure in endemic areas.
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PMID:Orbital Cysticercosis - masquerading as preseptal cellulitis with ptosis. 2736 71

Extraocular muscle cysticercosis usually presents with proptosis and restriction of eyeball movements. However, it can cause vision loss by compression of the optic nerve at the optic foramen in infrequent circumstances. We report a rare case with an unusual manifestation of ptosis, proptosis, lateral rectus palsy, and acute vision loss in the right eye. Magnetic resonance imaging was suggestive of cysticercal cyst. Emergency optic nerve decompression with cyst excision was done. Treatment of choice for extraocular muscle cysticercosis presenting with restriction of eyeball movements is mainly medical, consisting of albendazole and steroids. However, as this lesion rarely causes vision loss, indications of surgical decompression of optic nerve are not well defined. We recommend that early surgical management should be done along with medical treatment in cases of vision loss caused by extraocular muscle cysticercosis.
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PMID:Surgical Management of Extraocular Muscle Cysticercosis Causing Optic Foramen Syndrome. 3218 Nov 94


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