Three Cases of Chronic Cerebral Paragonimiasis

ABSTRACT

Although CNS involvement of paragonimiasis is not frequently encountered, it has been reported in 10-25% of clinical cases of all paragonimiasis. It causes various symptoms and signs including epilepsy, headache, hemiparesis, visual field defect or other neurologic deficits. Infestation usually occurs by ingestion of freshwater crabs or crayfish infected with Paragonimus metacercariae. We report three patients with chronic cerebral paragonimiasis, which were diagnosed by history, neurologic examination, radiological and serological evaluations, Two of them had history of ingestion of freshwater crabs or crayfish in childhood. Only one patient showed a positive enzyme-linked immunosorbent assay reaction for Paragonimus specific antibody in serum and CSF. Their clinical manifestations were seizure, headache, and visual field defect. In their plain skull X-rays, congregated round oval calcifications were recognized. Brain computed tomography of patients revealed pathognomonic findings of multiple, variable sized, round, calcified lesions surrounded by low density areas together with cortical atrophy in occipital, parietal, and temporal lobes.