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Gutierrez J, Katan M, Elkind MS. Inflammatory and Infectious Vasculopathies. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00036-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hwang YH, Son W, Kim YW, Kang DH, Chang HH, Goo YK, Hong Y, Chung DI. A Retrieved Sparganum of Spirometra erinaceieuropaei from a Korean Man during Mechanical Thrombectomy. THE KOREAN JOURNAL OF PARASITOLOGY 2020; 58:309-313. [PMID: 32615744 PMCID: PMC7338899 DOI: 10.3347/kjp.2020.58.3.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/05/2020] [Indexed: 11/23/2022]
Abstract
Human sparganosis is a zoonotic disease caused by infection and migration of the plerocercoid of Spirometra spp. Although sparganosis were reported from most parts of the body, the sparganum parasitizing inside cerebral artery is remarkably uncommon. We report a case of cerebral intravascular sparganosis in an elderly patient with acute ischemic stroke who was diagnosed by retrieving sparganum during mechanical thrombectomy. Finally, the parasites were identified as Spirometra erinaceieuropaei using multiplex PCR and cox1 gene sequencing.
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Affiliation(s)
- Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Wonsoo Son
- Department of Neurosurgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41944, Korea.,Department of Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Yong-Won Kim
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41944, Korea.,Department of Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Dong-Hun Kang
- Department of Neurosurgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41944, Korea.,Department of Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Hyun-Ha Chang
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Youn-Kyoung Goo
- Department of Parasitology and Tropical Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Yeonchul Hong
- Department of Parasitology and Tropical Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Dong-Il Chung
- Department of Parasitology and Tropical Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
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Zhu Y, Ye L, Ding X, Wu J, Chen Y. Cerebral sparganosis presenting with atypical postcontrast magnetic resonance imaging findings: a case report and literature review. BMC Infect Dis 2019; 19:748. [PMID: 31455261 PMCID: PMC6712767 DOI: 10.1186/s12879-019-4396-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/21/2019] [Indexed: 11/28/2022] Open
Abstract
Background Sparganosis, a rare and severe parasitic infection caused by the larvae of Spirometra species or simply sparganum, generally involves subcutaneous tissue or muscle. But occasionally, sparganum can also invade the human brain, resulting in cerebral sparganosis. Case presentation A 33-year-old woman presented with a 10-day history of headache. Postcontrast magnetic resonance imaging (MRI) revealed an irregular lesion with enhancement and the tunnel-shaped focus extending to the contralateral hemiphere. Cerebrospinal fluid (CSF) analysis disclosed pleocytosis (166 cells/μL) and an elevated protein concentration (0.742 g/L). Enzyme-linked immunosorbent assay (ELISA) revealed positive sparganum-specific antibody in both blood and CSF. Finally, the diagnosis of cerebral sparganosis was comfirmed. She received praziquantel treatment and got a favorable outcome during six-month follow-up. Conclusions Irregular enhancement and the tunnel sign that extends to the contralateral hemisphere on postconstrast MRI are unusual presentations of cerebral sparganosis. ELISA for sparganum-specific antibody can help confirm the diagnosis. Although surgery is the preferred treatment for cerebral sparganosis, praziquantel might also achieve satisfying outcomes.
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Affiliation(s)
- Yueli Zhu
- Department of Neurology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lingqi Ye
- Department of Neurology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiansan Ding
- Department of Neurology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jimin Wu
- Department of Neurology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yanxing Chen
- Department of Neurology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Gutierrez J, Katan M, Elkind MS. Collagen Vascular and Infectious Diseases. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00036-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
AbstractCerebral involvement in parasitoses is an important clinical manifestation of most of the human parasitoses. Parasites that have been described to affect the central nervous system (CNS), either as the dominant or as a collateral feature, include cestodes (Taenia solium (neurocysticerciasis), Echinococcus granulosus (cerebral cystic echinococcosis), E. multilocularis (cerebral alveolar echinococcosis), Spirometra mansoni (neurosparganosis)), nematodes (Toxocara canis and T. cati (neurotoxocariasis), Trichinella spiralis (neurotrichinelliasis), Angiostrongylus cantonensis and A. costaricensis (neuroangiostrongyliasis), Gnathostoma spinigerum (gnathostomiasis)), trematodes (Schistosoma mansoni (cerebral bilharziosis), Paragonimus westermani (neuroparagonimiasis)), or protozoa (Toxoplasma gondii (neurotoxoplasmosis), Acanthamoeba spp. or Balamuthia mandrillaris (granulomatous amoebic encephalitis), Naegleria (primary amoebic meningo-encephalitis), Entamoeba histolytica (brain abscess), Plasmodium falciparum (cerebral malaria), Trypanosoma brucei gambiense/rhodesiense (sleeping sickness) or Trypanosoma cruzi (cerebral Chagas disease)). Adults or larvae of helminths or protozoa enter the CNS and cause meningitis, encephalitis, ventriculitis, myelitis, ischaemic stroke, bleeding, venous thrombosis or cerebral abscess, clinically manifesting as headache, epilepsy, weakness, cognitive decline, impaired consciousness, confusion, coma or focal neurological deficits. Diagnosis of cerebral parasitoses is dependent on the causative agent. Available diagnostic tools include clinical presentation, blood tests (eosinophilia, plasmodia in blood smear, antibodies against the parasite), cerebrospinal fluid (CSF) investigations, imaging findings and occasionally cerebral biopsy. Treatment relies on drugs and sometimes surgery. Outcome of cerebral parasitoses is highly variable, depending on the effect of drugs, whether they are self-limiting (e.g. Angiostrongylus costaricensis) or whether they remain undetected or asymptomatic, like 25% of neurocysticerciasis cases.
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Kim IY, Jung S, Jung TY, Kang SS, Chung TW. Contralateral migration of cerebral sparganosis through the splenium. Clin Neurol Neurosurg 2007; 109:720-4. [PMID: 17630134 DOI: 10.1016/j.clineuro.2007.05.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 04/07/2007] [Accepted: 05/19/2007] [Indexed: 11/23/2022]
Abstract
Even though it has been known for some time that the cerebral sparganosis could migrate to the contralateral hemisphere, there have been no reports which described the route of migration. This paper reports a case of cerebral sparganosis which migrated from the right temporo-occipital lobe to the contralateral temporo-occipital lobe though the splenium over a period of 3 years. A 24-year-old man visited our hospital complaining of headache for about a month. Three years ago, non-contrast MRI had been performed in a local hospital, and the major finding was cortical atrophy and ventricular dilatation in the right temporo-occipital lobe area, which were compatible with cerebral sparganosis. After admission to our hospital, we performed MRI which showed a 2 cm-sized well-enhanced mass in the left temporo-occipital area. The findings of the right side were similar to the MRI checked 3 years ago. The presence of multiple calcifications and small enhanced lesions on the right side also indicated that the old lesion had been a cerebral sparganosis. The most important finding was that the FLAIR image showed that the entire splenium had high signal intensity which linked the high signal areas of both hemispheres. The patient underwent surgery with the guidance of neuronavigation. The mass was well-capsulated, and removed totally in an en bloc fashion. After opening the capsule, we found a long worm which showed the shape of a whole lava but no movement. The histopathological diagnosis was sparganosis.
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Affiliation(s)
- In-Young Kim
- Brain Tumor Clinic & Gamma Knife Center, Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam, Republic of Korea
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Abstract
The authors report the case of a 6-year-old boy with cerebral sparganosis due to infection with a plerocercoid tapeworm larva of Spirometra mansoni. Magnetic resonance imaging revealed an area of irregular long T2 signal in the right frontal lobe. When compared with images obtained 2 years earlier, the lesion appeared to have migrated into the parietal lobe. During surgery for the removal of a granuloma, the parasite was discovered and excised. Following surgery, the patient's neurological deficits markedly improved. The authors review the pathological and imaging features of cerebral sparganosis.
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Affiliation(s)
- Gao Bo
- Department of Radiology, Affiliated Hospital of Guiyang Medical College, Guiyang, Guizhou Province, People's Republic of China
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Abstract
Parasitic infection of the nervous system can produce a variety of symptoms and signs. Because symptoms of infection are often mild or nonspecific, diagnosis can be difficult. Familiarity with basic epidemiological characteristics and distinguishing radiographic findings can increase the likelihood of detection and proper treatment of parasitic infection of the nervous system. This article discusses the clinical presentation, diagnosis, and treatment for some of the more common infections of the nervous system caused by cestodes, trematodes and protozoans: Echinococcus spp., Spirometra spp. (sparganosis), Paragonimus spp., Schistosoma spp., Trypanosoma spp., Naegleria fowlerii, Acanthamoeba histolytica, and Balamuthia mandrillaris.
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Affiliation(s)
- M D Walker
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington 98104, USA
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