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 Table of Contents  
CME QUIZ
Year : 2019  |  Volume : 17  |  Issue : 2  |  Page : 45-46

Starry sky appearance


Department of Emergency Medicine, CMC, Vellore, Tamil Nadu, India

Date of Submission22-Jul-2019
Date of Acceptance05-Aug-2019
Date of Web Publication29-Aug-2019

Correspondence Address:
Dr. Darpanarayan Hazra
Department of Emergency Medicine, CMC, Vellore - 632 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_27_19

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How to cite this article:
Hazra D, Christopher A, Abhilash KP. Starry sky appearance. Curr Med Issues 2019;17:45-6

How to cite this URL:
Hazra D, Christopher A, Abhilash KP. Starry sky appearance. Curr Med Issues [serial online] 2019 [cited 2019 Sep 17];17:45-6. Available from: http://www.cmijournal.org/text.asp?2019/17/2/45/265824


  Question Top


Presenting a 25-year-old boy, with complaints of intermittent holocranial headache, associated with nausea, vomiting, double vision, horizontal diplopia, intermittent blurring of vision, followed by altered behavior, and memory loss.

Shown here is his noncontrast computed tomography (NCCT) brain, what is your diagnosis?


  Answer Top


Numerous calcified lesions scattered across the brain parenchyma, suggestive of neurocysticercosis in the calcified nodular stage.

Starry sky appearance in the NCCT brain is seen in patients with numerous neurocysticercosis which are calcified. Other differentials include tuberculomas, chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids micro abscess, toxoplasmosis, mycotic granulomas, low-grade astrocytoma, and cystic cerebral metastasis.[1]

Neurocysticercosis is a common parasitic disease of the nervous system caused by Taenia solium, mostly seen in the rural population due to poor sanitation. Cysticercal encephalitis is an unusual presentation in patients with multiple intracranial cysts, in whom inflammation of brain parenchyma occurs due to toxic reaction to cysticercal antigens which are released after the death of cysts either spontaneously or due to cysticidal therapy.[2]

[Figure 1] NCCT brain showed numerous calcified lesions, in the brain parenchyma, suggestive of neurocysticercosis in the calcified nodular stage.
Figure 1: Noncontrast computed tomography brain.

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Saranya D, Jawahar M, Bhanu K. A case of disseminated neurocysticercosis. Ann Indian Acad Neurol 2011;14:56-7.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Garcia HH, Pretell EJ, Gilman RH, Martinez SM, Moulton LH, Del Brutto OH, et al. A trial of antiparasitic treatment to reduce the rate of seizures due to cerebral cysticercosis. N Engl J Med 2004;350:249-58.  Back to cited text no. 2
    


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