Papilledema From Intraventricular Neurocysticercosis

Awoman in her 30s presentedwith a 3-month history of bilateral blurry vision with transient visual obscurations and a 1-month history of tinnitus. Funduscopic examination findings were concerning for bilateral optic disc edema, which was worse in the right eye compared with the left (Figure 1). Magnetic resonance imaging of thebraindemonstratedmultiple cysts in theposterior fossa, including a large cyst inducing obstructive hydrocephalus at the level of the fourthventriclemeasuring1.2cm × 1.6cminanteroposteriorand transverse dimensions (Figure 2). She underwent emergent suboccipital craniotomy with removal of the cysts and placement of a temporary external ventricular catheter. Cerebrospinal fluid analysis results revealed no protein, white blood cells, or organisms. Surgical pathology confirmed the diagnosis of neurocysticercosis. The patient was treated for 14 days with 400mg twice daily of albendazole by mouth along with intravenous dexamethasone, 2 mg, twice daily followed by a rapid oral corticosteroid taper. Follow-up cerebrospinal fluid analysis results revealed rare white blood cells, no protein, and no organisms. Twomonths later, the patient presentedwith continued blurry vision and bilateral sixth nerve palsies and required ventriculoperitoneal shunt placement owing to a communicating hydrocephalus. At follow-up, the patient had resolution of all visual symptoms. Follow-up magnetic resonance imaging demonstrated reduction in size of the culprit cyst to 0.5 cm × 0.8 cm in anteroposterior and transverse dimensions.