Neurocysticercosis Presenting as Bipolar Disorder and Chronic Papilledema: A Rare Case Report and Review

Abstract

A 40 year old female presented with mania, abnormal behaviour, headache & gradual progressive diminution of vision & history of pork consumption. Anterior segment examination OU was normal. Fundus of both eyes showed B/L established papilledema. Visual Acuity was 20/125 both eyes. CT & MRI with contrast revealed multiple well defined rounded CSF density cysts with a central mural nodule representing a scolex showing ring enhancement and perilesional edema. The largest lesion was 7.7×9 mm and multiple lesions were noted in both cerebral hemisphere and internal capsular regions, right cerebellar hemisphere and pons suggestive of disseminated neurocysticercosis. B-scan revealed disc edema and increased optic nerve diameter by more than 5 mm in both eyes confirming papilledema. She was prescribed albendazole, praziquantel, steroids, mannitol, acetazolamide and lithium. With this treatment her mania and headache resolved and her vision in both eyes improved to 20/40. Fundus examination after 3 months showed resolving papilledema. CT & MRI now showed marked decrease in number and regression in size of cyst and lesions. Bipolar disorder (mania & abnormal behavior) can be the first presenting sign of neurocysticercosis and papilledema. The probable explanation for maniac presentation in neurocystecercosis is due to some changes in neurotransmitter level. Papilledema was due to raised ICP suggested by perilesional edema in CT scan & MRI, and disc edema with increased optic nerve diameter in both eyes by more than 5 mm in B-scan.