Claude's syndrome associated with neurocysticercosis

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.

Fig. 1

Brain MRI. (A) Initial FLAIR image shows high signal intensity on left midbrain and perilesional edema. (B) Initial contrast enhanced T1-weighted image shows cystic lesion with peripheral ring enhancement. The lesion involves dorsal midbrain tegmentum, left third cranial nerve fascicle, and superior cerebellar peduncle, but not the red nucleus. The lesion is located posterior and inferior to the red nucleus. (C and D) Follow up MRI after three months, reveals disappearance of perilesional edema and ring enhancement.