Clinical features,radiological characteristics,and pathological changes in 42 patients with cerebral sparganosis

Abstract

Objective To investigate the clinical features, the radiological characteristics, and the pathological changes of cerebral sparganosis. Methods We retrospectively collectted and summarized the clinical data of 42 patients with cerebral sparganosis from the Iinstitute of Anti-parasitic Diseases of Jiangxi Province and the First Affiliated Hospital of Nanchang University during January 2000 to January 2014. The follow-up period of the 42 patients ranged from 4 to 96 months. Results Forty-two cases (30 males and 12 females) with cerebral sparganosis were enrolled in the study. Among the 42 patients, 34 cases suffered from seizures, 16 cases experienced headaches, and 14 cases had limb weakness. The brain CT scan showed the small and punctuate calcifications scattering around the lesions in 18 cases. The features of enhanced MRI included aggregating ring-like enhancement in 38 cases, lesions in 14 cases, and lesion migration in 13 cases. Twenty-four of the 42 patients were performed surgery. The brain tissues revealed multiple inflammatory tunnels, in which live or degenerated larvae were identified in 20 cases, but only eosinophilia tunnels were observed in the other 4 cases. The serum and cerebro-spiral fluid specimens from 18 patients without surgery were positive to spirometra mansoni antigen. Their cerebral lesions disappeared and got a favorable prognosis after administration of praziquantel in long term follow-ups. Conclusions There is a high incidence of cerebral sparganosis in Poyang lake basin. The clinical features of cerebral sparganosis mainly include seizure, headache and hemiparesis. The enhanced lesions show knot or tunnel signs on multi-planar MRI which are associated with the multiple inflammatory tunnels of larvae migration. A long-term administration of high dose opraziquantel can also get a good treatment prognosis without the classical surgical therapy for cerebral sparganosis. Key words: Sparganosis; Central nervous system parasitic infections; Diagnostic imaging; Praziquantel