Importance of Ophtalmological Examination
In The Face of Suspicion of Neurocysticercosis
Rajaona Ranto Andriatsilavina1*, Rasolonjatovo Emilson2, Rafanomezantsoa Rindra1, Miray
Louis De Gonzague1, Razafimahefa Julien3, Raobela Lea1
1Department of Ophthalmology HJRA Hospital, University of Antananarivo Madagascar
2Department of Neurosurgery, HJRA Hospital, University of Antananarivo, Madagascar
3Department of Neurology, Befelatanana Hospital, University of Antananarivo, Madagascar
Ranto Andriatsilavina Rajaona, Department of Ophthalmology HJRA Hospital, University of Antananarivo Madagascar, Tel
no: 00261331103381 ; E-mail:
Received: 26 September, 2016; Accepted: 15 October, 2016; Published: 25 October, 2016
Andriatsilavina RR, Emilson R, Rindra R, De Gonzague ML, Julien R, et al. (2016) Importance of Ophtalmological Examination
In The Face of Suspicion of Neurocysticercosis. Int J Open Access Ophthal 1(3): 2. DOI: 10.15226/2474-9249/1/3/00107
Introduction: Cysticercosis is a parasitosis due to the
development of cysticercus larva in various tissues of organism. This
infection constitutes a chief problem of public health in developing
countries like Madagascar.
The purpose of the study is to report one case of neuroocular
cysticercosis and to emphasize the importance ophtalmological
examination if neurocysticercosis is suspected.
Observation: We report the case of 20 years old man at whom
a translucent cystic lesion animated with peristaltic movement was
discovered during the funduscopic examination that permitted to
diagnose a neurocysticercosis.
Discussion: In the discussion, we will stress the importance
of ophtalmological examination in the face of all suspicion of
Conclusion: All in all, in view of the high prevalence of this
disease in Madagascar, ophtalmological consultation is of paramount
Keywords: Ocular cysticercosis ; Ophtalmological examination;
Cysticercosis is humans infection by larval form of Taenia
solium. This disease constitutes a chief problem of public health
in developing countries where hygiene is poor. Otherwise,
neurocysticercosis is an emerging disease in developed
countries, due to increased immigration from endemic areas,
mainly in Latin America. Cysticercosis affects an estimated 50
million people worldwide . Madagascar, with around 10% of
prevalence is among the most touched nations by this infection.
Cysticercosis can infest any organs, especially central nervous
system, whereas ophtalmological involvement is rare . We
report a case of intraocular cysticercosisthat led to a diagnosis of
We report a case of 28 years old man, medical student,
who came to the consultation for progressive painless vision
loss from left eyes which began since about one month prior
to eye check. Concerning his past history, he does not have any
medico-surgicals particular issues, apart from a habit of eating
raw porcsausages during his childhood. The story had started
two months before he went to ophtalmological consultation.
He had had unusual temporal cephalgia associated with a
painful left eye for several days. Therefore, he went to a general
practitioner who prescribed him a stage 2 analgesic that slightly
relieved the symptoms. He carried out first ophtalmological
consultation with a liberal ophthalmologist who prescribed
glasses thinking that headaches were due to ametropia, visual
acuity was normal in both eyes, examination of the fundus was
not performed. Then, the appearance of Bravais Jacksonian
type epileptic seizures combined with absence were the causes
of his admission to neurology service. The brain CT scan was
normal [Figure 1]. Biological examination showed a normal
CRP lower than 5Mg/l, the hematocrit at 50,5%. The hemogram
found out an hypereosinophilia at 3 Giga per liter, both CRL
(Cerebrospinal Liquid) analysis and cysticercosis serology are
normal. Consequently, the diagnosis couldn't be discovered,he
was given laroxyl as treatement and discharged from hospital.
The neurological symptoms disappeared. But after getting out of
hospital, his vision began to decrease rapidely pushing him to go
to ophtalmological consultation in hospital again ten days later.
The ocular exam in left eye showed: visual acuity was hand
movement. The anterior segment was normal, particularly,
anterior uveitis, pupillary reflexes were positives, IOP is
14mmHg. In funduscopic examination, however, there was
an hyalitis estimated to 3 crosses with a spheric translucent
cystic formation.This is a whitish stain animated by a peristaltic
movement when triggered by light. Right eye exam was normal.
The cysticercosis was finally diagnosed.
Cysticercosis is a larval cestodose due to the growth in the
humans the tænia solium larva . This is a strict small intestine
parasitic of humans (definitive hosts). Nevertheless, humans
might accidentally become intermediate hostsof T solium;
these larva can determine, according to their localisations, a
cysticercosis in the following sites: cerebral , cuteneo-muscular,
ocular . Madagascar belongs to the very high endemicity
regions with prevalence rate which vary from 7 to 21% according
to the regions .
Cysticercosis affects especially the central nervous system
with prevalence from 60 to 90%  of cases. By contrast, ocular
localization is rare, in about 5% of cases, whose 90% located in
posterior segment (vitreous, subretinal) .
Clinical diagnosis of neurocysticercose is based on a
lot of beams of argument such as (faecal peril, promiscuity
humans pigs, measly meat consumption), clinical (convulsion),
biological (blood hypereosinophilia), tomodensitometrical
(parenchymatous form). Immunology and anatomopathology are
needed for biological diagnosis . In our case, immunological
blood examination, CRL as well as cerebral imaging couldn't
manage to confirm the diagnosis. However,the ophtalmological
symptoms that occurred secondarily led to a certain diagnosis in
which intravitreous cyst was seen. Actually the ophtalmological
(fundus) examination only permit to unveil the diagnosis in
presence of intravitreous or subretinal mobile translucent cyst
Neurocysticercosis is the most serious emerging and
reemerging disease. This parasitosis is responsible for 50.000
death every year according to WHO . It is one of the most
frequent causes of epilepsy in developing countries, unfortunately,
it is not always easy to diagnose due to the shortage of technical
Hence, ophtalmological consultation especially fundus
examination is of paramount importance if cysticercosis is
suspected in an endemic area. Otherwise, its important to
suspected when the symptoms are compatible in a patient from
an endemic area.
- Aubry P, Bequet D, Queguiner P. Cysticercosis: a frequent and redoubtable parasitic disease. Med Trop(Mars). 1995;55(1):79-87.
- Andriantsimahavandy A, Ravaolimalala VE, Rajaonarisoa P. Ravoniarimbinina P; Rakotondrazaka M, Raharilaza N, et al. The current epidemiological situation of cysticercosis in Madagascar. Arch Inst Pasteur Madagascar. 2003;69(1-2):46-51.
- Bernardin Prisca, Auzemzry A, Rabenatoandro C. Ocular cysticercosis (O.C.) in Madagascar. Rev Int Trach Pathol Ocul Trop Subtrop Sante Publique. 1994; 71:103-113.
- Bronstein JA, Klotz F. Cestodoses larvaires. EMC-Maladies Infectieuses. 2005;2(2):59-83. doi : 10.1016/j.emcmi.2004.11.002.
- Auzemery A, Andriantsimahavaandy a, Bernardin P, Queguiner P. Cysticercose intra-vitréenne, evolution spontanée, à propos d'un cas. J Fr Ophtalmol. 1996;19: 556-558.
- Roman G, Sotelo J, Del Brutto O, Flisser A, Dumas M, Wadia N, et al. A proposal to declare neurocysticercosis an international reportable disease. Bulletin of the World Health Organization. 2000;78(3):399-406.