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

Abstract

A 64-year-old man presented with generalized tonic clonic convulsion followed by weakness of the right lower extremity. He had a medical history of hypertension, hyperlipidemia, and right cerebellar infarction. Computed tomography (CT) showed a small high density nodule with an enhanced perifocal low density area in the left occipital lobe. T 1 -weighted magnetic resonance (MR) imaging showed a ringshaped and partial string-like nodule with enhancement by gadolinium. T 2 -weighted MR imaging showed the white matter of the left occipital lobe as high intensity. CT and MR imaging seemed to indicate metastatic brain tumors, although cortical atrophy and ventricular dilation were recognized. Left parietal craniotomy was performed under stereotactic targeting to obtain a definitive diagnosis. During manipulation at the center of the targeted lesion, a white, tape-like body was found and recognized to be a live worm. Serological testing revealed strong immunopositivity against Spirometra mansoni. The infection route in the present case was probably through eating raw chicken meat. Cerebral sparganosis is extremely rare but should be considered in the differential diagnosis of metastatic brain tumors, especially in endemic areas.

CT and MR Characteristics of Cerebral Sparganosis

“…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.…”

Other cestodes

“…The first three mechanisms are particularly common in Asia, while drinking contaminated water is the most common mechanism of infection in other regions. Cerebral sparganosis most often occurs in adults, with fewer cases in adolescents and children (Nobayashi et al, 2006; Song et al, 2007; Anantaphruti et al, 2011). A disproportionate 10:1 male:female seroprevalence ratio for sparganosis has been reported (Lee et al, 2002) but the male: female ratio in published cases of cerebral sparganosis is 3:2 (Holodniy et al, 1991; Kim et al, 1996; Song et al, 2007; Choi et al, 2010; Anantaphruti et al, 2011).…”

“…The spargana is a thin, white solid flatworm ranging from a few millimeters to several centimeters in length (Fig. 27.2)(Nobayashi et al, 2006), enclosed within a gliotic wall and surrounded by inflammatory exudates (Anders et al, 1984; Rengarajan et al, 2008). Histologically, spargana differ from other cysticerci by the absence of bladder walls, a hooked scolex or suckers, and the presence of a solid noncavitated body.…”

Diagnosis and stereotactic aspiration treatment of cerebral sparganosis: summary of 11 cases

“…monitoring of existing cases. 19,24 In the present study, we retrospectively analyzed the clinical manifestations, imaging features, and therapeutic procedures for 11 patients with cerebral sparganosis and summarized the experience gained from stereotactic operations for the treatment of this disease.…”