Clinical features and misdiagnosis analysis of children with cerebral paragonimiasis with intracranial hemorrhage as initial symptom / 中华实用儿科临床杂志

Objective To explore the clinical characteristics and the cause of misdiagnosis of child suffering from cerebral parago-nimiasis with intracranial hemorrhage as initial symptom,and to improve the diagnosis and treatment level of cerebral paragonimiasis.Methods The clinical data of the children who suffered from cerebral paragonimiasis with intracranial hemorrhage as initial symptom were collected from January 2011 to December 2015 in Affiliated Hospital of Zunyi Medical College.The clinical manifestation,imageology and laboratory tests,outcome of therapy were analyzed and then the effect of treatment and the prognosis were followed up.Results There were 7 patients meeting the inclusion criteria for cerebral paragonimiasis,including 4 male and 3 female.They were from 6 to 13 years old with the average age of 9.3 years old.All patients presented with headache and vomiting,and showed intracranial hemorrhage through CT or MRI of brain.All of the 7 patients were misdiagnosed as cerebrovascular malformation by the neurosurgeons.Three of them showed typical imaging pattern including tunnel sign and the ring-like shape of cerebral paragonimiasis.Five of these cases were attacked by pulmonary distomiasis at the same time.Six of them had an increasing eosinophil,and the paragonimus antibody was positive.They were treated with Praziquantel.Six patients recovered completely,and 1 patient had the dysfunction of left extremities.Conclusions The childhood cerebral paragonimiasis has strong clinical heterogeneity and diversity in manifestation.Intracranial hemorrhage may be the initial symptom,which should be paid more attention to.Cerebral paragonimiasis can be diagnosed and treated early according to the clinical characteristics,the increase of eosinophil,the typical changes in imageology and the specific antibody test.

The Return of an Old Worm: Cerebral Paragonimiasis Presenting with Intracerebral Hemorrhage

Paragonimiasis is caused by ingesting crustaceans, which are the intermediate hosts of Paragonimus. The involvement of the brain was a common presentation in Korea decades ago, but it becomes much less frequent in domestic medical practices. We observed a rare case of cerebral paragonimiasis manifesting with intracerebral hemorrhage. A 10-yr-old girl presented with sudden-onset dysarthria, right facial palsy and clumsiness of the right hand. Brain imaging showed acute intracerebral hemorrhage in the left frontal area. An occult vascular malformation or small arteriovenous malformation compressed by the hematoma was initially suspected. The lesion progressed for over 2 months until a delayed surgery was undertaken. Pathologic examination was consistent with cerebral paragonimiasis. After chemotherapy with praziquantel, the patient was monitored without neurological deficits or seizure attacks for 6 months. This case alerts practicing clinicians to the domestic transmission of a forgotten parasitic disease due to environmental changes.

The Return of an Old Worm: Cerebral Paragonimiasis Presenting with Intracerebral Hemorrhage

Paragonimiasis is caused by ingesting crustaceans, which are the intermediate hosts of Paragonimus. The involvement of the brain was a common presentation in Korea decades ago, but it becomes much less frequent in domestic medical practices. We observed a rare case of cerebral paragonimiasis manifesting with intracerebral hemorrhage. A 10-yr-old girl presented with sudden-onset dysarthria, right facial palsy and clumsiness of the right hand. Brain imaging showed acute intracerebral hemorrhage in the left frontal area. An occult vascular malformation or small arteriovenous malformation compressed by the hematoma was initially suspected. The lesion progressed for over 2 months until a delayed surgery was undertaken. Pathologic examination was consistent with cerebral paragonimiasis. After chemotherapy with praziquantel, the patient was monitored without neurological deficits or seizure attacks for 6 months. This case alerts practicing clinicians to the domestic transmission of a forgotten parasitic disease due to environmental changes.

Cerebral Paragonimiasis Presenting as Recurrent Hemorrhagic Stroke without Pulmonary Symptoms

No abstract available.

Cerebral Paragonimiasis and Bo Sung Sim's Hemispherectomy in Korea in 1950s-1960s / 의사학

This paper deals with cerebral paragonimiasis and cerebral hemispherectomy conducted as a treatment of cerebral paragonimiasis by Bo Sung Sim in Korea in 1950s-1960s. He demonstrated that cerebral hemispherectomy could be used for unilateral diffuse cerebral paragonimiasis. Sim learned cerebral hemispherectomy from Dr. L. A. French. at the University of Minnesota from 1955 to 1957 in America. The authors argues that Bo Sung Sim's introduction of cerebral hemispherectomy to Korea was not a simple application of an advanced medical technology, but a complicated and active process in that Sim used the technique to intervene intractable complications from cerebral paragonimiasis such as generalized convulsions, spastic hemiplegia and mental deterioration. Bo Sung Sim, one of the neurosurgeons of the first generation in Korea, was trained in neurology, neuropathology, neuroradiology and animal experiments as well as in neurosurgery at the University of Minnesota. After returning to Korea, Sim faced parasitic diseases, one of the most serious public health problems at that time, which were far different from what he learned in America. As a neurosurgeon, Sim tackled with parasitic diseases of the central nervous system with various diagnostics and therapeutics. In 1950s, more than one million populations suffered from pulmonary paragonimiasis acquired by eating raw crabs or by feeding juice of crushed crayfish for the treatment of measles in Korea. About 26.6 percent of people with paragonimiasis had cerebral paragonimiasis. Before bithionol therapy was introduced in 1962, neurosurgery was the only available treatment to control increased intracranial pressures, intractable epilepsy, paralysis and mental deterioration. Between 1958 to 1962, Bo Sung Sim operated on 24 patients of cerebral paragonimiasis. In two of them, he performed cerebral hemispherectomy to control intractable convulsions when he found diffuse cerebral paragonimiasis and cerebral atrophy at the operating table. The two patients were recovered dramatically after the operation. The first patient became a part of medical campus for 20 years after hemispherectomy, doing chores at the hospital and helping Bo Sung Sim for his teaching neuroanatomy. The presence of the hemispherectomized patient in the classroom impressed the students deeply. Furthermore, the hemispherectomized patient stimulated Sim and his school to perform research upon the neuroanatomy and neurophysiology of the brain with hemispherectomized animals.

Epilepsy Surgery of the Cerebral Paragonimiasis

OBJECTIVE: The authors investigate appropriate evaluation and surgical methods in treatment of the cerebral paragonimiasis accompanying epilepsy. METHODS: Thirteen patients with the cerebral paragonimiasis accompanying epilepsy were included for this study. Preoperative evaluation methods included history taking, skin and serologic tests for Paragonimus westermani, neurologic examinations, computerized tomography, magnetic resonance imaging, amytal test, PET or SPECT, and video-EEG monitoring with depth and subdural grid electrodes. Seizure outcome was evaluated according to Engel's classification. RESULTS: Surgical methods were temporal lobectomy including lesions in six, lesionectomy in five, and temporal lobectomy plus lesionectomy in two. Postoperative neurological complications were not noticed, and seizure outcomes were class I in 12 patients (92%), class II in one (8%). CONCLUSION: In patients with a cerebral paragonimiasis accompanying epilepsy, further evaluation methods must be done to define the epileptogenic zone, and complete resection of the epileptogenic zone with different surgical methods should be performed for seizure control.

Cerebral Paragonimiasis Treated with Praziquantel: Case Report

Cerebral paragonimiasis, occuring as an extrapulmonary infestation, still reamans an important intracranial parasitic disease in Korea. The authors report a 32-year-old female patient who had developed headache, vomiting and signs of the left hemispheric dysfunction for 5 months. A diagnosis of the cerebral paragonimiasis was made on the basis of brain CT findings, a positive intradermal test, and the positive results of serum and CSF levels of the anti-Paragonimus IgG antibodies(by micro-ELISA). She was treated with 75 mg/kg/day of praziquantel for 7days to confirm healing of the intracranial lesion by the follow-up brain CT and micro-ELISA associated with a marked clinical improvement. This case report highly suggests the anticipated effectiveness of praziquantel in the treatment of the cerebral infestation of Paragonimus westermani, especially in its early stage.

A Case of Multiple Huge Brain Abscesses Caused by Paragonimiasis

Cerebral paragonimiasis, occurring as an extrapulmonary infestation, is one of the important intracranial lesions in Korea. We have experienced a case of multiple huge brain abscesses caused by cerebral paragonimiasis. The patient, 17 year old boy, had chief complaints of headache and vomiting followed by mental deterioration. Neurologically, the patient presented mental change, papilledema, left abducense palsy and right hemiparesis. The treatment included the closed drainage followed by total removal of abscess capsules which was confirmed histopathologically. This paper is concerned with the description of the clinical features of cerebral paragonimiasis and review of literatures.