Cerebral Sparganosis:MR Imaging Features and Pathology / 实用放射学杂志

Objective To analyze MRI manifestations of cerebral sparganosis and the diagnostic value of MRI.Methods MRI findings in 8 patients with proven cerebral sparganosis by pathological examination were reviewed.Results The lesions were hypointense on T1WI and hyperintense on T2WI with edema of brain around the lesions.Most of the lesions were markedly enhanced with ring-type,nodules,tortous beaded shape or tortuous linear like worm past-enhanced scans.The location and shape of the lesions in 3 cases were changed on followed-up MRI.Conclusion There are some specific pathological findings in cerebral sparganosis.MRI is of important clinical value in diagnosis and differential diagnosis of cerebral sparganosis.

Cerebral Sparganosis with Apoplectic Presentation

Cerebral sparganosis is a rare parasitic infestation of the brain, usually presenting with seizure associated with chronic recurrent inflammatory reaction. Recently we have treated a very unusual form of this parasitic disease, of which clinical onset was apoplectic. A 60-year-old man was transferred to our emergency room complaining of sudden onset of right hemiparesis and speech impairment. Computed tomography(CT) of the brain demonstrated high density lesion, suggestive of a hematoma in the left parietal subcortical region. Unusual location and shape of the hematoma made us took CT angiogram to confirm any vascular abnormalities in or around the hematoma. We performed an explorative craniotomy and evacuation of the hematoma under the guidance of stereotactic system. At surgery, a live parasite, a larva of a tapew (Spirometra mansoni) was found and removed with the hematoma.

A Case of Cerebral Sparganosis: Technetium-99m-ECD Brain SPECT experience

Cerebral sparganosis is a rare intracranial parasitic infectious disease. The best treatment seems to be the surgical removal of the worm and granuloma. However, it has not been proved possible to determine whether the worm is dead or alive by a single Brain CT or MRI findings. We report clinical and technetium-99m-ethyl cysteinate dimer (99mTc-ECD) cerebral perfusion SPECT findings in a case with 57-year-old cerebral sparganosis patient. During 3 years of follow-up, the patient did not have any newly developed neurological signs. Follow-up serum/CSF ELISA tests for sparganosis were positive and the worm was presumed to be in a dormant stage. Cerebral perfusion SPECT showed an irregular shaped area with decreased 99mTc-ECD uptake. The brain SPECT findings in our patient could not be exactly explained with the worm 's natural history. However, the brain SPECT may be helpful in determining the treatment of newly diagnosed cerebral sparganosis patients.

A Case of Sparganosis in the Bifrontal Intracerebral Region

Cerebral sparganosis is an uncommon parasitic zoonosis caused by a migrating plerocercoid tapeworm larva of the genus Spirometra. On computed tomography scans, the following characteristics were reported:1) unilateral involvement;2) extensive or multifocal areas of low density along the white matter bundles with ipsilateral ventricular dilatation and localized cortical atrophy;3) nodular or irregular enhancement with spotty calcification;and 4) change in the location of enhancing nodules on sequential scans. In this report, a 46-year-old female patient was suffering from generalized tonic-clonic seizure and headache. A computed tomography scan revealed a nodular high density contrast enhancement with small calcification against low density background. These computed tomography scan findings were thought to be characteristic for cerebral sparganosis mansoni. But the unique feature in this case was bilateral involvement. We therefore report this rare case of bifrontal intracerebral sparganosis together with some discussion of the literature.

Clinical Analysis of Cerebral Sparganosis

The tape-worm spirometra mansonoides infests man world-widely, particularly in Asian countries with rare involvement of the central nervous system. Recently, the authors have experienced 7 cases of cerebral sparganosis, and reviewed their clinical manifestation, radiographic findings, operative and pathologic findings, and follow-up results. The cerebral sparganosis manifests headache, seizure, or hemiparesis. Most of patient had episodes of eating frogs or snakes. The brain CT scan showed low density area with ipsilateral ventricular dilatation. Enzyme linked immunosorbent assay(ELISA) test showed positive response to serum and cerebrospinal fluid. The best treatment for cerebral sparganosis mansoni is surgical removal, from which we confirmed 4(17%) cases of live worms in operative and patholgic findings, and most of the seizure disappeared or decreased after operation.