Parasitic lesion of the insula suggesting cerebral sparganosis: case report

Abstract

Cerebral sparganosis, a parasitic disease, rarely produces a chronic active inflammatory response in the brain. Clinically and radiographically the process may mimic a neoplasm. We report a 30-year-old man who underwent surgical exploration for a mass in the insular cortex. Histology revealed a densely fibrotic mass heavily infiltrated with plasma cells and lymphocytes, in which were embedded parasitic forms consistent with sparganosis. We describe the MRI appearances and pathologic features. Intracranial mass lesions secondary to sparganosis must be considered in patients with a history of travel to endemic areas, especially Asia.

CT and MR Characteristics of Cerebral Sparganosis

“…16 The common routes of infection in humans were described above, but the exact route of infection to the brain is still uncertain. The larvae may migrate through the loose connective tissues of the foramina of the skull base around the nerves or vessels.…”

“…It is difficult to make a preoperative diagnosis, and most cerebral sparganoses are diagnosed by surgical resection of the worm and pathologic examination. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] However, with the development of serologic techniques and radiologic instruments, proper diagnosis of cerebral sparganosis could be established before surgery. To date, to our knowledge imaging findings of cerebral sparganosis have been reported sporadically, most of which 4,5,17,18 were published in the 1990s, but the features on CT and MR examinations had not previously been described in detail.…”

Migration: A Notable Feature of Cerebral Sparganosis on Follow-Up MR Imaging

“…8 A definite diagnosis of cerebral sparganosis is challenging due to its nonspecific clinical manifestation. Previously, it was often misdiagnosed as a neoplasm, 9 infarct, 10 tuberculoma, 11 or other diseases. With the availability of high-resolution CT and MR imaging, the ELISA test for parasitic antibodies, and stereotactic biopsy, more cases of sparganosis are being diagnosed currently.…”

Surgical Removal of a Live Worm by Stereotactic Targeting in Cerebral Sparganosis-Case Report-

“…The infection route in the present case was probably through eating raw chicken meat, which the patient did approximately once a month before the convul- Cerebral sparganosis was first reported in 1918, 12) and most cases have been reported from Asia, including Korea and Japan. 1,[3][4][5][6]8,10,11,15) The route of infection to the central nervous system is not yet known, but the sparganum may unintentionally migrate through the foramina of the skull base and vertebral column along the loose connective tissue around the vessels or nerves. A live worm was removed in nine previous cases (Table 1).…”