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Peer-reviewedCC BY-NC-SASurgical neurology international

Isolated midbrain neurocysticercosis presenting as trochlear nerve palsy.

  • Bernardo Ramos Fraga1
  • Carolina Calderón Ochoa1
  • José Ramón Olivas-Campos1
  • Matias Baldoncini2
  • Alvaro Campero3
  1. 1Department of Neurosurgery, UMAE Hospital de Especialidades No. 25, Centro Médico Nacional Noreste, Instituto Mexicano del Seguro Social, Monterrey, Mexico.
  2. 2Department of Neurosurgery, San Fernando Hospital, Buenos Aires, Argentina.
  3. 3Department of Neurosurgery, Hospital Padilla de Tucuman, Tucuman, Argentina.
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Abstract

Background

Neurocysticercosis (NCC) is a neurological infection caused by the larval stage of the tapeworm Taenia solium. It can be found in the brain parenchyma or in the intraventricular and subarachnoid spaces and the spinal cord, giving rise to different clinical manifestations and prognoses. Isolated brainstem NCC is rare, with few cases reported in the literature. We describe a case of isolated NCC in the midbrain. The clinical presentation, diagnostic approach, and surgical management with histopathological confirmation are reported.Case description

A 33-year-old male presented to the emergency department with a 1-month history of increased diplopia during the vertical gaze. Neurological examination revealed a positive Bielschowsky's head tilt test, consistent with a right trochlear nerve palsy. Magnetic resonance imaging of the head revealed a cystic lesion in the left midbrain. The patient underwent a suboccipital craniotomy with a telovelar approach, and gross total resection of the lesion was achieved. Histopathological analysis revealed a brainstem cysticercus. Following surgery, the patient received albendazole and steroids. Conjugate eye movements were recovered during the 1-year follow-up period.Conclusion

This case report highlights the importance of considering NCC as a differential diagnosis for cystic lesions of the brain, even when they are found in atypical locations. Surgical excision should be considered in cases with mass effect or uncertain diagnosis.

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Cite

BibTeXRIS
BibTeX
@article{fraga2026isolated,
  title = {{Isolated midbrain neurocysticercosis presenting as trochlear nerve palsy.}},
  author = {Bernardo Ramos Fraga and Carolina Calderón Ochoa and José Ramón Olivas-Campos and Matias Baldoncini and Alvaro Campero},
  journal = {Surgical neurology international},
  year = {2026},
  month = oct,
  doi = {10.25259/sni_598_2026},
  url = {https://europepmc.org/article/MED/42974273},
  note = {CC BY-NC-SA},
}
RIS
TY  - JOUR
TI  - Isolated midbrain neurocysticercosis presenting as trochlear nerve palsy.
AU  - Bernardo Ramos Fraga
AU  - Carolina Calderón Ochoa
AU  - José Ramón Olivas-Campos
AU  - Matias Baldoncini
AU  - Alvaro Campero
PY  - 2026
DA  - 2026/10/09
JO  - Surgical neurology international
DO  - 10.25259/sni_598_2026
UR  - https://europepmc.org/article/MED/42974273
AB  - Background  Neurocysticercosis (NCC) is a neurological infection caused by the larval stage of the tapeworm Taenia solium. It can be found in the brain parenchyma or in the intraventricular and subarachnoid spaces and the spinal cord, giving rise to different clinical manifestations and prognoses. Isolated brainstem NCC is rare, with few cases reported in the literature. We describe a case of isolated NCC in the midbrain. The clinical presentation, diagnostic approach, and surgical management with histopathological confirmation are reported.Case description  A 33-year-old male presented to the emergency department with a 1-month history of increased diplopia during the vertical gaze. Neurological examination revealed a positive Bielschowsky's head tilt test, consistent with a right trochlear nerve palsy. Magnetic resonance imaging of the head revealed a cystic lesion in the left midbrain. The patient underwent a suboccipital craniotomy with a telovelar approach, and gross total resection of the lesion was achieved. Histopathological analysis revealed a brainstem cysticercus. Following surgery, the patient received albendazole and steroids. Conjugate eye movements were recovered during the 1-year follow-up period.Conclusion  This case report highlights the importance of considering NCC as a differential diagnosis for cystic lesions of the brain, even when they are found in atypical locations. Surgical excision should be considered in cases with mass effect or uncertain diagnosis.
SN  - 2229-5097
SN  - 2152-7806
ER  -