Vision Loss in Neurocysticercosis: A Systematic Review of Case Reports and Series.

Background And Purpose: Neurocysticercosis is a parasitic infection caused by larvae that leads to various neurological symptoms, including vision loss. This systematic review analyzed cases of vision loss associated with neurocysticercosis to assess its etiology and vision outcomes.

Methods: Following PRISMA guidelines, the review included reports on human subjects with vision loss due to neurocysticercosis and is registered with PROSPERO (CRD42024556278). The PubMed, Scopus, Embase, and Google Scholar databases were searched.

Results: This review included 149 records from 176 patients with a mean age of 27.5 years, comprising 40.3% females, 59.1% males, and 0.6% subjects of unknown sex. Most cases were from Asia, predominantly India. The illness duration varied, but was mostly between 1 and 6 months. In addition to vision loss, common symptoms were headache or orbital pain (30.7%), seizures (12.5%), and altered consciousness (5.7%). Vision loss was mainly unilateral (72.7%). Imaging abnormalities included multiple cystic brain lesions (16.5%), enhanced lesions (4.0%), and calcified lesions (2.3%). Intravitreal and retinal regions were most affected (52.3%), followed by the anterior chamber (6.2%), orbital apex (5.1%), and optic nerve (6.2%). Anticysticercal drugs were the primary treatment, with 57.4% of cases showing improvement. Surgical excision was performed in 40.9% of cases with intravitreal or retinal cysts.

Conclusions: Vision loss in neurocysticercosis is mainly due to intravitreal and retinal involvement, and is frequently associated with multiple cystic brain lesions. Anticysticercal drugs can produce improvements, though surgical intervention is often needed for intravitreal or retinal cysts. Most of the patients in this review improved, though severe outcomes such as eye loss were reported.