Bilateral disk edema with unilateral macular serous fluid secondary to neurocysticercosis

Abstract

The purpose of this article is to document a case of neurocysticercosis that manifested clinically with bilateral disk edema and serous fluid accumulation in the macula of the left eye. We also describe the recovery of visual-field loss (O.D.) and diminution of bilateral disk edema following anti-helminthic treatment. A 41-year-old woman reporting headaches came to us with bilateral disk edema and co-existing serous macular fluid in the left eye. Magnetic resonance imaging (MRI) revealed the presence of large multi-septated cysts that exhibited peripheral enhancement, with minimal surrounding edema at the posterior left temporal lobe. Scattered punctate lesions, suggesting areas of calcification, were also observed within both temporal lobes. The optic chiasm appeared compressed. This presentation was considered characteristic of neurocysticercosis and the patient was prescribed a regimen of 200mg albendazole b.i.d. The patient responded well to the treatment, with progressive resolution of the bilateral disk edema and macular fluid. Although rare, cases of cysticercosis and neurocysticercosis may still be encountered in industrialized nations, where the parasite has been almost eradicated. Ocular signs of disk edema and macular serous fluid secondary to neurocysticercosis may correspond to optic nerve, parenchymal, or extraparenchymal disease.