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      Claude's Syndrome Associated with Neurocysticercosis

      case-report

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          Abstract

          Claude's syndrome is a distinctive brainstem syndrome characterized by ipsilateral third cranial nerve palsy with contralateral hemiataxia and is due to an intrinsic or extrinsic lesion in the midbrain. We report a case of Claude's syndrome caused by neurocysticercosis infection. A 68 year-old Asian man was admitted to our hospital because of ataxia, left ptosis, and diplopia. Brain magnetic resonance imaging (MRI) showed a cystic lesion in the midbrain, which was surrounded by ring enhancement and peripheral edema. Neurocysticercosis infection was diagnosed by the cerebral spinal fluid study. The patient was treated with albendazole and steroids. A follow-up brain MRI three months later demonstrated the disappearance of a surrounding brain edema and rim enhancement. The most common cause of Claude's syndrome is cerebrovascular disease and malignancy. However, there is no report caused by neurocysticercosis infection. Therefore, if we encounter Claude's syndrome, we should consider neurocysticercosis infection as one of the etiologic factors.

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          Proposed diagnostic criteria for neurocysticercosis.

          V Rajshekhar, Stimson P Schantz, O Del Maschio … (2001)
          Neurocysticercosis is the most common helminthic infection of the CNS but its diagnosis remains difficult. Clinical manifestations are nonspecific, most neuroimaging findings are not pathognomonic, and some serologic tests have low sensitivity and specificity. The authors provide diagnostic criteria for neurocysticercosis based on objective clinical, imaging, immunologic, and epidemiologic data. These include four categories of criteria stratified on the basis of their diagnostic strength, including the following: 1) absolute--histologic demonstration of the parasite from biopsy of a brain or spinal cord lesion, cystic lesions showing the scolex on CT or MRI, and direct visualization of subretinal parasites by funduscopic examination; 2) major--lesions highly suggestive of neurocysticercosis on neuroimaging studies, positive serum enzyme-linked immunoelectrotransfer blot for the detection of anticysticercal antibodies, resolution of intracranial cystic lesions after therapy with albendazole or praziquantel, and spontaneous resolution of small single enhancing lesions; 3) minor--lesions compatible with neurocysticercosis on neuroimaging studies, clinical manifestations suggestive of neurocysticercosis, positive CSF enzyme-linked immunosorbent assay for detection of anticysticercal antibodies or cysticercal antigens, and cysticercosis outside the CNS; and 4) epidemiologic--evidence of a household contact with Taenia solium infection, individuals coming from or living in an area where cysticercosis is endemic, and history of frequent travel to disease-endemic areas. Interpretation of these criteria permits two degrees of diagnostic certainty: 1) definitive diagnosis, in patients who have one absolute criterion or in those who have two major plus one minor and one epidemiologic criterion; and 2) probable diagnosis, in patients who have one major plus two minor criteria, in those who have one major plus one minor and one epidemiologic criterion, and in those who have three minor plus one epidemiologic criterion.
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            Uncommon presentations of neurocysticercosis.

            I.M.S. Sawhney, G. Singh, O.P Lekhra … (1998)
            Neurocysticercosis commonly presents with seizures, raised intracranial tension and dementia. The unusual location of the cysts may result in uncommon manifestations mimicking a host of neurological disorders. Ten patients with neurocysticercosis with rare clinical presentations have been described in this series. These include dorsal midbrain syndrome, isolated bilateral ptosis, papillitis, cerebral hemorrhage, painful cervical radiculopathy, progressive swelling of arm, paraplegia due to intramedullary cyst, third ventricular cyst, dystonia and nominal aphasia masquerading as transient ischaemic attacks. The clinical details and possible mechanisms for these rare presentations are discussed.
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              Aortic Embolism in Claude’s Syndrome

              Ralf Baumgartner, Christine Kremer (2002)
              Article 0 comments Cited 9 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Yonsei Med J
                Journal ID (publisher-id): YMJ
                Title: Yonsei Medical Journal
                Publisher: Yonsei University College of Medicine
                ISSN (Print): 0513-5796
                ISSN (Electronic): 1976-2437
                Publication date (Print): 01 November 2010
                Publication date (Electronic): 30 September 2010
                Volume: 51
                Issue: 6
                Pages: 978-979
                Affiliations
                [1 ]Department of Neurology, JungAng General Hospital, Jeju, Korea.
                [2 ]Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
                [3 ]Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
                Author notes
                Corresponding author: Dr. Kyung-Yul Lee, Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, 712 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea. Tel: 82-2-2019-3325, Fax: 82-2-3462-5904, kylee@ 123456yuhs.ac
                Article
                DOI: 10.3349/ymj.2010.51.6.978
                PMC ID: 2995972
                PubMed ID: 20879071
                SO-VID: 3d0cf613-524b-4756-a6db-f0b260af8a34
                Copyright © © Copyright: Yonsei University College of Medicine 2010
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 06 December 2008
                Date revision received : 27 February 2009
                Date accepted : 15 March 2009
                Categories
                Subject: Case Report
                Subject: Infectious Diseases

                ScienceOpen disciplines: Medicine
                Keywords: claude's syndrome,ataxia,neurocysticercosis
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: claude's syndrome, ataxia, neurocysticercosis

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