Central American mesencephalopathy

A 31-year-old Hispanic laborer sought medical attention for a four-day history of posterior headaches and double vision. The headache spontaneously resolved, but the patient continued to experience vertical diplopia. The neuro-ophthalmic exam revealed minimal anisocoria and subtle deficits of vertical motion of the left eye. MRI scanning demonstrated a lesion within the midbrain on the left side. Lumbar puncture revealed cells consisting primarily of lymphocytes and eosinophils. Both serum and cerebrospinal fluid revealed glycoproteins indicative of a cysticercosis infection. The patient was treated with Praziquantel and steroids with improvement of his oculomotor function.