Abstract
Cerebral sparganosis is clinically non-specific and easily misdiagnosed, exposing patients to the risk of severe brain damage and neurological dysfunction caused by actively migrating larvae. Diagnostic biomarkers from typical cases can help to establish an early diagnosis and proper treatment. We present a 25-year-old woman who suffered from 9 years of refractory epilepsy and was misdiagnosed with glioma and subjected to surgery. The postoperative pathology confirmed granuloma, and the tumor-like foci reappeared 3 months later. Along with the “tunnel sign” on MRI, cerebral sparganosis was suspected and confirmed by positive serum and cerebrospinal fluid antibodies against Spirometra mansoni. The patient visited us after a failure of four cycles of praziquantel treatment, recurrent seizures and hemiplegia with basal ganglia foci. Craniotomy was not carried out until the larva moved to the superficial lobe on follow-up MRIs, and pathology revealed sparganosis granuloma. The patient became seizure-free and recovered myodynamia but had long-lasting cognitive dysfunction due to severe brain damage. This case indicated the importance of tunnel signs and moving tumor-like foci on MRI as diagnostic clues of cerebral sparganosis. An early diagnosis is vitally important to avoid severe neural dysfunction by the long-living and moving larvae. Surgical removal of the larva is a critical remedy for cases failed by praziquantel treatment.
Highlights
Cerebral sparganosis is a cerebral parasitic infection caused by the sparganum, the metacestode larva of Spirometra mansoni, which has a strong contraction ability, moves into the brain tissue and lives in necrotic tunnels, causing formation of a parasite granuloma, typically with eosinophil infiltration
Cerebral sparganosis is misdiagnosed as dysembryoplastic neuroepithelial tumor (DNET), glioma or a cerebral abscess [3] because the lesion commonly features space-occupying foci with enhancement, edema and mass effects on computed tomography (CT) or magnetic resonance imaging (MRI), and the diagnosis is challenging, especially during the early disease stage
Cerebral sparganosis can be misdiagnosed as transfer tumors that typically present with irregular enhancement with ring-shaped edema at a fixed position on MRI and as cerebral cysticercosis, since the patients often have a contact history of eggs of Taenia solium and typical cyst images in the brain [10]
Summary
Cerebral sparganosis is a cerebral parasitic infection caused by the sparganum, the metacestode larva of Spirometra mansoni, which has a strong contraction ability, moves into the brain tissue and lives in necrotic tunnels, causing formation of a parasite granuloma, typically with eosinophil infiltration. The pathological result indicated that after four circles of anthelmintic therapy by praziquantel, the larva was dead at the end of the course and formed the parasite granuloma with inflammatory reaction and AEDs was ineffective Her postoperative recovery was uneventful without neurological dysfunction except an increased tendon reflex of the left limbs at discharge and she was prescribed two FIGURE 2 | Larval samples and the pathologic results of cerebral sparganosis in the case. Her Mini-Mental State Examination (MMSE) score was 27 (losing three scores for orientation to space and time), and her Montreal Cognitive Assessment (MoCA) score was 24 (losing one score for visuospatial cognition, one score for naming, one score for attention and three scores for delayed memory) Her follow-up MRI scanning indicated only slight dural enhancement in the bilateral frontal lobe and anterior cingulate (Figure 1F), and EEG indicated intermittent middle amplitude 5–7 Hz slow waves on bilateral frontal electrodes with right side predominant. Our case demonstrates how cerebral sparganosis can be misdiagnosed and how important an early diagnosis and treatment is to avoid permanent and severe brain damage and to achieve a good prognosis
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