Bilateral near total blindness due to miliary neurocysticercosis

Description

A man aged 18 years presented to our neuro-ophthalmology clinic with symptoms of headache, and painless and gradual onset bilateral visual loss since 2 months. While systemic examination was normal, visual acuity was noted to be perception of light in both eyes. Both pupils reacted sluggishly to light. Both eyes were found to be normal on examination apart from minimal temporal optic disc pallor. Urgent MRI of the head and orbits was ordered, which revealed numerous foci of neurocysticercosis (NCC) scattered throughout the brain parenchyma, giving it a 'starry sky appearance' (figure 1A). The occipital lobe was also found to be studded with such lesions along with surrounding oedema. A prominent cyst, along with scolex, was found to be lodged near the chiasma, compressing it and the emanating optic nerves (figure 1B, C).

Figure 1

Neuroimaging of miliary neurocysticercosis. (A) T2W axial image showing...

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