Xie Dan, Wang Min, Chen Xu, Tuo Hou-Zhen
Department of Neurology, Beijing Friendship Hospital Affiliated to Capital Medical University, No. 95th Yongan Road, Xicheng District, Beijing, 100050, China.
Liver Research Center, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, 100050, China.
BMC Neurol. 2019 May 29;19(1):105. doi: 10.1186/s12883-019-1335-1.
Sparganosis mansoni is a parasitic disease caused by infection with the larvae of Spirometra spp. tapeworms. Its clinical manifestations and severity depend on the migration and the location of the parasites. The proportion of cerebral sparganosis in all Spirometra mansoni infections is 13.5% in Thailand and 12.4% in China. In the clinical setting, cerebral sparganosis is often misdiagnosed due to atypical characteristics, irregular intracranial location, and atypical epidemiology.
The patient in the case study suffered from an acute paroxysmal attack of lateral numbness, accompanied with focal epilepsy. He was admitted to the neurology department as a stroke patient but was later diagnosed with cerebral sparganosis mansoni following lab and radiology investigations. He was fully recovered and free of Spirometra mansoni one year after initial consultation following several courses of oral praziquantel. The current report focuses on the diagnosis, treatment and follow up of this patient.
A case of cerebral sparganosis mansoni with a stroke-like onsetsuggests that in the clinical diagnosis, neurologists should pay attention to brain lesions and look out for the possibility of neuroparasitic infections when dealing with patients with stroke-like onset accompanied by epilepsy. Detections of relevant antibodies in blood and cerebrospinal fluid may be necessary. The combination of the epidemiological history, clinical manifestations, detection of parasite antibody, head radiology, pathological biopsy, and identification of parasites will help us in diagnosis and differential diagnosis.
曼氏裂头蚴病是一种由裂头绦虫属幼虫感染引起的寄生虫病。其临床表现和严重程度取决于寄生虫的移行和寄生部位。在泰国，所有曼氏裂头蚴感染中脑裂头蚴病的比例为13.5%，在中国为12.4%。在临床环境中，由于其非典型特征、颅内位置不规律以及流行病学不典型，脑裂头蚴病常被误诊。
该病例研究中的患者出现急性阵发性肢体麻木发作，并伴有局灶性癫痫。他以卒中患者身份入住神经内科，但在经过实验室和影像学检查后，后来被诊断为曼氏脑裂头蚴病。在接受了几个疗程的口服吡喹酮治疗后，患者在初次就诊一年后完全康复且体内无曼氏裂头蚴。本报告重点关注该患者的诊断、治疗及随访情况。
一例以卒中样起病的曼氏脑裂头蚴病病例提示，在临床诊断中，神经科医生在处理有癫痫发作的卒中样起病患者时，应注意脑部病变并警惕神经寄生虫感染的可能性。可能需要检测血液和脑脊液中的相关抗体。结合流行病学史、临床表现、寄生虫抗体检测、头部影像学、病理活检以及寄生虫鉴定将有助于我们进行诊断和鉴别诊断。
