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Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...
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Obstructive hydrocephalus due to CNS toxocariasis.

Jae-Hwan Choi1, Jae-Wook Cho, Jae-Hyeok Lee

  • 1Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Republic of Korea.

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Central nervous system toxocariasis, a parasitic infection, can cause serious neurological symptoms. This case highlights the importance of considering Toxocara infection in patients with unexplained hydrocephalus and neurological deficits.

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Ophthalmology

Background:

  • Toxocariasis is a parasitic infection caused by the roundworm Toxocara.
  • Ocular and visceral larva migrans are common presentations.
  • Neurocysticercosis is a rare but serious central nervous system manifestation.

Observation:

  • A 46-year-old man presented with headache, diplopia, and visual obscuration.
  • Funduscopic examination revealed bilateral optic disk swelling.
  • Brain MRI showed hydrocephalus, leptomeningeal enhancement, and hemosiderin deposition.

Findings:

  • Cerebrospinal fluid (CSF) analysis indicated elevated opening pressure, xanthochromia, and red blood cells.
  • Enzyme-linked immunosorbent assay (ELISA) detected elevated antibody titers against Toxocara in blood and CSF.
  • Findings suggest active inflammation due to CNS toxocariasis.

Implications:

  • CNS toxocariasis should be considered in the differential diagnosis of obstructive hydrocephalus and neurological symptoms.
  • Prompt diagnosis and treatment are crucial to prevent severe neurological sequelae.
  • This case underscores the importance of serological testing for Toxocara in suspected cases.