Neurocysticercosis presenting as isolated wall-eyed monocular internuclear ophthalmoplegia with contraversive ocular tilt reaction

Abstract

Neurocysticercosis is a common tropical infection presenting with neurological signs. It commonly presents as seizures but various other focal neurological presentations have been reported. Though neurocysticercosis have been reported to present as isolated internuclear ophthalmoplegia, we report the first case of neurocysticercosis presenting as wall-eyed monoocular internuclear ophthalmoplegia syndrome with contraversive ocular tilt reaction.

Wall-Eyed Monocular Internuclear Ophthalmoplegia (WEMINO) and Millard-Gubler Syndromes in a Patient with Isolated Pontine Infarction: Topographic, Oculomotor, and Radiological Analysis of Two Very Uncommon Conditions

“…There are few reports of patients with this clinical condition. Ikeda and Okamoto [17] presented a case with transient exotropia and two other cases with similar characteristics in combination with a contraversive ocular tilt reaction caused by infarction and neurocysticercosis [14, 18]. Similarly, we found a WEMINO syndrome report with skew deviation and facial paralysis also describing symptoms that were transient but with no contralateral hemiparesis [19].…”

“…In one report, Johnston and Sharpe [13] found pontine tegmental histopathological damage that spared the oculomotor nucleus; so, we cannot completely explain this exotropia by a paresis of the third cranial nerve. One hypothesis suggests that abnormal vestibular signals that reach the medial rectus nucleus induce an asymmetry of muscle tone and the consequent ocular abduction towards the injured side [14]. Here, early vertigo might support the latter argument for an imbalance in the central vestibular tone.…”

Removal of an Impaled Intraocular Hair Comb Following Self-inflicted Trauma

“…10,11 Intraorbital trauma should be explored for globe rupture and optic nerve injuries. [12][13][14] Classic signs of optic nerve compromise include decreased visual acuity, APD, and dyschromatopsia. 15 In our patient the imaging demonstrated an intact globe and the presence of a transient optic neuropathy, as evidenced by initial presence of APD, likely attributable to perineural inflammation from the adjacent FB Image 1.…”

Neurocysticercosis presenting as a vertical one-and-a-half syndrome with associated contralesional horizontal gaze paresis

“…Lath and Rajshekhar reported one patient with retraction nystagmus and bilateral horizontal gaze-evoked nystagmus due to a dorsal midbrain lesion [8]. Six patients presented with internuclear ophthalmoplegia and one patient had isolated horizontal one-and-a-half syndrome [10,23,24]. In conclusion, intrinsic thalamomesencephalic NCC is very rare, and the clinical presentation unusual, in that particularly in the young other differential diagnosis such as multiple sclerosis, arteriovenous malformations, tuberculomas or even lacunar strokes should be considered at first in non-endemic areas.…”