Extraocular muscle cysticercosis presenting as Brown syndrome

PURPOSE: Report of a case of acquired Brown syndrome caused by infestation of the superior oblique muscle by Cysticercus cellulosae. METHOD: Case seen in a referral practice. A 20-year-old man presented with recurrent attacks of conjunctivitis and diplopia in upgaze. Clinical examin ation of ocular motility established a diagnosis of acquired Brown syndrome of the right eye. Computed tomography of the right orbit unequivocally est ablished the diagnosis of superior oblique muscle cysticercosis. The patien t was started on systemic steroids and albendazole in the prescribed doses for a month. RESULT: Serial computed tomography scans of the orbit revealed resolution o f the cystic lesion after a month. Clinically, although there was restorati on of ocular motility in upgaze, mild restriction of movement of the right eye in levoelevation persisted. However, the patient was symptomatically be tter with amelioration of the recurrent conjunctivitis and diplopia in prim ary gaze. CONCLUSION: Extraocular muscle cysticercosis should be considered in the di fferential diagnosis of acquired motility disorder. The presentation of ext raocular muscle cysticercosis as an acquired Brown syndrome is unusual. Res ponse to medical therapy was satisfactory. (Am J Ophthalmol 2001;131:526-52 7. (C) 2001 by Elsevier Science Inc. All rights reserved).