Shadow in front of the left eye for 8 months, headache for one month, blurred vision and tinnitus for 2 weeks

Abstract

A 19-year-old female was admitted to our department, complaining of shadow in front of the left eye for 8 months, headache for one month, blurred vision and tinnitus for 2 weeks. Bilateral papilledema was the presumed diagnosis. Neurological examination revealed modest left abducens nerve palsy, diplopia, nystagmus and a stiff neck. Lumbar puncture demonstrated marked intracranial hypertension (>330 mmH 2 O, normal range 70-180 mmH 2 O), modestly elevated protein (0.61 g/L, normal range 0.15-0.45 g/L), low concentration of glucose (1.90 mmol/L, normal range 2.80-4.50 mmol/L) and moderate pleocytosis (116/uL, normal range 0-8/uL). CSF cytology suggested lymphocyte-dominant inflammation with elevated ratio of eosinophils (5%, normal range 1-2%). Cranial MRI demonstrated a subarachnoid cystic lesion located at the right temporal lobe, 2 round-like cystic lesions located at the prepontine region. The positive antibodies to T. solium in serum and CSF further confirmed the diagnosis of neurocysticercosis. The patient received oral administration of antiparasitic drug (albendazole 0.40 g twice a day), intravenous infusion of mannitol (125 ml 2-4 times a day) and steroids (dexamethasone 5 mg twice a day) for 3 weeks. The patient experienced a febrile headache as the dose of steroids was reduced, but was rapidly resolved after resuming the steroids as well as intravenous antibiotics (ceftriaxone sodium, 1 g twice a day). After treatment, repeated cranial MRI demonstrated that the subarachnoid cystic lesion located at the right temporal lobe was modestly resolved, while lesions located at the prepontine region remained almost unchanged. The patient was then discharged, and was told to repeat the regimen 2-3 times at an interval of one month. DOI: 10.3969/j.issn.1672-6731.2015.06.016