LYCOS RETRIEVER 
Cysticercosis: Cases
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Cysticercosis presenting as a nodule or mass in the tongue is a very rare occurrence. Only thirty four cases have been reported in the world literature. This is therefore a diagnostic and therapeutic dilemma for clinicians. Solitary nodular swelling over tongue is usually not suspected clinically for cysticercosis. The diagnosis is usually made on histopathological examination. The ensuing clinical disorder is named after the name given to the organism at this larval stage, Cysticercosis cellulosae, Larvae of pork tapeworm Taneia Solium.
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Cysticercosis is a common infestation of the central nervous system. Spinal involvement is rare and varies from 0.7 to 5.85%.[5],[6],[7] Spinal forms have been identified in the vertebral, extradural, intradural and intramedullary regions. Intramedullary cysticercosis is very uncommon and only 45 cases have been reported so far.[1],[8] Migration of the cysticercus through the ventriculo-ependymal pathway and hematogeneous dissemination have been identified to be the possible pathogenetic mechanisms. The higher incidence in the thoracic spinal cord is possibly related to the high blood flow in the thoracic segment of the spinal cord.[1],[5],[9] In the absence of previous history of neurocysticercosis or subcutaneous nodules it may be difficult to clinically suspect intramedullary cysticercosis. High eosinophil count and calcification of soft tissues in the plain radiogram may be suggestive, but such findings are rare.[1],[10] Cerebrospinal fluid and serum enzyme-linked immunoelectric transfer blot assay for cysticercus antibodies may be helpful.[11] MRI clearly delineates the lesion. Concurrent presence of cerebral and muscular cysticercosis in the presence of spinal cysticercosis has been reported.[12],[13] Results of surgery have not been encouraging till a decade back[8],[9] and this has been attributed to parenchymal gliosis as result of toxic waste products of larva, pachymeningitis and vascular insufficiency.[2],[5],[8] However, in the microsurgical era, good surgical outcome has been reported.[1],[13]
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[A] high index of suspicion is required for the diagnosis of ocular cysticercosis because of the endemic nature of this infestation in this geographic location. Ultrasonography B scan and ELISA for anti cysticercal antibodies help to establish the diagnosis. A combination of oral albendazole and corticosteroids is given in confirmed cases. Intraocular cysticercosis is associated with a poor prognosis for vision.
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A variety of surgical techniques may be used to treat certain individuals with cysticercosis. Hydrocephalus may be treated by the insertion of a tube (shunt) to drain excess cerebrospinal fluid (CSF) away from the brain and into another part of the body where the CSF can be absorbed. Surgical excision of cysts (cysticerci) may be performed in certain cases. Cysticerci affecting the eyes may ... be treated surgically.
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In the present study of 10 cases of ocular cysticercosis, intraocular cysticercosis was the predominant form accounting for 40% of cases [Table - 1]. Of more than 500 cases collected in several series, about 4% occurred in the orbit or eyelids, 20% occurred in the subconjunctival area, 8% occurred in the anterior segment, 68% occurred in the posterior segment of which 41% either subretinally or intraretinally, while 27% occurred in the vitreous.[5]
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