Cerebral paragonimiasis is a serious manifestation of paragonimiasis, and refers to a parasitic brain infection caused by a the Paragonimus genus of trematodes (flukes).
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Epidemiology
Paragonimiasis is endemic in Asia, West Africa, and Latin America. Infections can occur after ingesting undercooked freshwater crayfish, crabs, or shrimp that are infected with encysted larvae 1,2.
The primary habitat of adult Paragonimus in humans is the lung, and the most severe complication is secondary to the erratic migration of paragonimiasis to the brain 3.
Clinical presentation
Symptoms of the central nervous system usually present after the onset of pulmonary symptoms and can include headaches, seizures, blurred visions, and gait disturbance or even paralysis 3,4.
Pathology
The pathological basis of cerebral paragonimiasis is the mechanical damage by the migration of flukes to the brain, inflammatory response, toxicity, and defense reactions. The pathological changes include inflammation and cerebral hemorrhage 1-4.
Paragonimiasis can also be diagnosed by examining the fluke or its eggs in the cerebrospinal fluid or brain.
The ELISA test should confirm the diagnosis.
Radiographic features
MRI
MRI demonstrates characteristic tunnel-like regions of signal abnormality which represent the migrating track of the adult worm. Additionally, ring-like shapes or clusters of multiple ring-like enhancing lesions have been reported 1-4. The areas surrounding the lesions usually show widespread inflammatory changes.
A relatively common complication is lobar intracerebral hemorrhage which is seen in approximately 25% of patients. SWI is helpful in the detection of the focus of bleeding in the subacute and chronic phases 3-5.
Treatment and prognosis
Praziquantel is the treatment for human paragonimiasis and achieves 100% efficiency 1-5.
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