Neurocysticercosis in a postpartum woman: BMJ case report
A 23-year-old woman with a history of childbirth 2 weeks back presented with binocular diplopia and slight blurring of vision in both eyes (BE) for last 1 week. She also had four bouts of vomiting with associated nausea and hemicranial dull headache for last 3 days.

The antenatal and immediate perinatal period was uneventful. Previous history, as well as systemic history, was not significant. The patient was afebrile. On systemic examination, neck stiffness could be elucidated. The blood pressure was recorded to be 124/74 mm Hg. Ocular examination revealed the visual acuity to be 20/40 in BE.

There was restricted abduction of the right eye and diplopia charting revealed isolated sixth cranial nerve palsy. Pupillary reaction was brisk in BE with no evidence of relative afferent pupillary defect. Slit lamp evaluation of the anterior segment showed no abnormality. On fundus evaluation, bilateral disc oedema with ill-defined disc margins was noted.

MRI brain and orbit with MR venography was advised. An urgent referral was made to the neurologist for evaluation and consideration for lumbar puncture and cerebrospinal fluid analysis after controlling intracranial tension (ICT). MRI brain and orbit revealed multiple foci of cystic lesions throughout the brain parenchyma suggestive of neurocysticercosis (NCC) with signs of increased ICT and optic nerve kinking.

No intraocular or extraocular cysts were detected. Under neurologist’s guidance, an urgent management with intravenous mannitol, oral acetazolamide was instituted to decrease the raised ICT. Oral steroids and prophylactic oral antiepileptics were also started.

Learning points
• Diagnosis and management of neurocysticercosis (NCC) during pregnancy and postpartum period are challenging.

• History of exposure in endemic area, personal, family and social history are very crucial in suspecting the diagnosis in patients with neurological symptoms.

• Cysticercosis can be transmitted horizontally from the mother to the newborn. Hence, in mothers with NCC, screening for tapeworm infection is exigent.

• Postpartum diplopia should be investigated thoroughly.

• Early management is mandatory in case of postpartum women to prevent untoward outcomes.

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