Department of Neurology, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, Jiangxi Province 330006, China.
J Clin Neurosci. 2013 Nov;20(11):1514-9. doi: 10.1016/j.jocn.2012.12.018. Epub 2013 Jul 30.
Cerebral sparganosis is a severe parasitic infection caused by the larvae of Spirometra mansoni. We retrospectively reviewed the clinical data of 26 patients with cerebral sparganosis diagnosed in our center and reviewed the literature on cerebral sparganosis in mainland China. Among our 26 patients, 20 suffered from seizures, 11 had limb weakness and 11 experienced headaches. The characteristic MRI features included ring-like enhancement in 24 patients, tunnel lesions in 14 patients and lesion migration in seven patients. Twenty-three patients underwent surgery, with the brain tissues of all patients revealling many inflammatory tunnels. Inside these tunnels, live or degenerate larvae were identified in 20 patients, but only eosinophilic tunnels were identified in the three remaining patients. All patients in this series received praziquantel, with three patients receiving praziquantel alone, with no surgical intervention, and all had a favorable outcome on long term follow-up. At least 82 patients with cerebral sparganosis with histo pathological confirmation have been reported in mainland China. The clinical course, radiological features, and pathological features of mainland Chinese patients were mostly similar to those reported in other regions. There exists an inherent correlation between radiological features and pathological changes, with worm migration causing multiple inflammatory tunnels, especially eosinophilic tunnels, which thus form the basis of tunnel-like or ring-like enhancement on multi-planar MRI, and might be predictors for a poor prognosis. Surgical therapy is optimal in the treatment for cerebral sparganosis, but medication (praziquantel and dexamethasone) has achieved favorable outcomes in some patients.
脑裂头蚴病是由曼氏迭宫绦虫幼虫引起的严重寄生虫感染。我们回顾性分析了在我中心诊断为脑裂头蚴病的 26 例患者的临床资料，并复习了中国大陆脑裂头蚴病的文献。在我们的 26 例患者中，20 例有癫痫发作，11 例有肢体无力，11 例有头痛。MRI 的特征性表现包括 24 例患者有环形强化，14 例患者有隧道样病变，7 例患者有病变迁移。23 例行手术治疗，所有患者的脑组织均发现许多炎症性隧道。在这些隧道中，20 例患者的隧道内发现有活的或退化的幼虫，但在另外 3 例患者中仅发现有嗜酸性隧道。本系列所有患者均接受了吡喹酮治疗，其中 3 例患者单独使用吡喹酮，未行手术干预，长期随访结果均良好。中国大陆至少有 82 例经组织病理学证实的脑裂头蚴病患者。中国大陆患者的临床过程、影像学特征和病理学特征与其他地区报道的大多相似。影像学特征与病理学变化之间存在固有相关性，虫体迁移导致多个炎症性隧道，尤其是嗜酸性隧道，这是多平面 MRI 上形成隧道样或环形强化的基础，也可能是预后不良的预测因素。手术治疗是脑裂头蚴病的最佳治疗方法，但药物（吡喹酮和地塞米松）治疗在某些患者中也取得了良好的效果。
