Acquired brown syndrome secondary to superior oblique muscle cysticercosis

Acquired Brown syndrome is known to occur after trauma, iatrogenic events, cysts of superior oblique muscle tendon, and inflammation. The purpose of this study is to report a large series of patients with acquired Brown syndrome secondary to superior oblique muscle cysticercosis and to discuss its management.

Retrospective analysis was performed of clinical and imaging features, management, and outcome in seven patients with cysticercosis of the superior oblique muscle presenting clinically as Brown syndrome.

Seven patients were identified (five male and two female) ranging in age from 6 to 45 years. All patients had the ocular motility limitation, ie, limitation of elevation in adduction., characteristic of Brown syndrome. This was associated with pain and swelling in the superior nasal orbit. Diagnosis was established by observing the cysticercus cyst with scolex on imaging (ultrasound B scan, magnetic resonance imaging, and/or computed tomography). Oral albendazole (15 mg/kg) and oral prednisolone (1mg/kg) were given for 4 weeks, and the patients were followed up for 1 year. Clinical recovery with improvement of ocular motility and regression of imaging features was noted in all patients.

Acquired Brown syndrome secondary to superior oblique muscle cysticercosis is a rare entity. Awareness of this condition, which leads to early diagnosis and institution of prompt medical treatment, results in a successful clinical outcome.