Cerebral paragonimiasis

Abstract

Cerebral paragonimiasis is an important neurological problem in the Far East, especially in Korea. It is estimated that about 5000 cases were living in Korea in January, 1966. A clinical study of 62 patients seen at the Department of Neurology, National Medical Centre, Seoul, Korea, revealed: 1. (1) Cerebral paragonimiasis is predominantly a disease of children and adolescents, affecting males more than females. Seizures, headache, visual disturbance, motor and sensory disturbance are the 5 most common symptoms and mental deterioration, hemiplegia, unilateral hemi-hypaesthesia, homonymous hemianopsia, and optic atrophy are the 5 major signs. 2. (2) Cysto-nodular types of lesions may be seen on chest X-ray and multiple areas of “soap bubble” calcification which may appear in the posterior regions on skull X-ray are diagnostic. Pneumoencephalography shows moderate to marked subcortical atrophy in the majority of patients and a space-occupying lesion may be found in some of the patients. Angiography is useful in localization in cases simulating brain tumor. 3. (3) Abnormal laboratory findings other than the demonstration of ova which are helpful in making the diagnosis include: an abnormal colloidal gold curve, increased γ-globulin, the presence of eosinophilia and a positive complement fixation test in the spinal fluid. The EEG is likely to be abnormal. 4. (4) Death may occur due to an acute exacerbation of cerebral paragonimiasis. Once the disease becomes stabilised, its course is benign. 5. (5) Bithionol, a drug specific for paragonimiasis, is only effective in acute, active cases, but not in chronic, inactive cases. Craniotomy is indicated only in the tumorous form. Diagnostic criteria and the rules for estimating the activity of the infection are presented. Guidelines for treatment and modern concepts of pathogenesis are discussed.