关键词: 脑裂头蚴病, 活虫, 癫痫, 磁共振成像, 显微外科手术

Abstract:

Objective To analyze the clinical features, treatment and prognosis of cerebral sparganosis, providing reference for clinical managemet. Methods Clinical data of 83 patients with cerebral sparganosis in Guangdong 999 Brain Hospital from July 2004 to January 2020 were collected, and the general conditions, clinical manifestations, laboratory examination, imaging features, treatment and prognosis were analyzed. Statistical analysis was performed using the SPSS 19.0 software. Results The 83 patients came from different areas of China, including 46 from Guangdong Province, 12 from Hunan Province, 11 Guangxi Province, 8 Jiangxi Province and 6 other Provinces (municipalities/autonomous regions). There were 48 males and 35 females. The youngest case was 8 years old and the oldest was 71. The longest course of disease was 360 months and the shortest was 2 days. A clear history of unhygienic diet was found in 68.7% (57/83) patients. The main clinical symptoms were epilepsy (84.3%, 70/83), headache (32.5%, 27/83), mild limb hemiplegia (26.5%, 22/83), speech disorder (10.8%, 9/83), visual impairment (7.2%, 6/83), and paresthesia (6%, 5/83). All patients received Routine blood examination was provided for all patients, and found an increase of leukocyte count in 7 of 83 cases, 9 cases with increased eosinophils count, and 4 cases with increased lymphocytes. C-reactive protein detection was performed in 27 cases, and 2 cases showed elevation. Serological detection of metacercaria antibody by ELISA was performed in 80 patients, and 77 cases showed positive results. Detection of antibody against metacercaria in cerebrospinal fluid was examined by ELISA for 46 cases, of them 23 cases were found positive. Seventy patients were examined by electroencephalogram, 30 cases showed abnormal slow wave, and 17 cases had epileptiform discharge and clinical seizure. Calcification was observed on CT scan of 41 cases. Brain MRI enhancement showed tunnel sign-like changes in 75 cases and beading-like enhancement in 83 cases. Fifty-eight patients were treated with surgery, and 43 white flat cotton threadlike live worms were obtained from 42 of them. At follow-up of 3 months to 8 years, 52 cases were cured, 6 cases were still progressing or not cured; 55 patients with epilepsy who underwent surgery were followed up, of them 80% (44/55) reached the modified Engel classification class Ⅰ. Twenty-five cases were treated with praziquantel, and at follow up for 3 months to 8 years, 7 cases were cured, 18 cases were still progressing or not cured. Eleven patients with epilepsy were treated with praziquantel and followed up, and only 27.3% (3/11) reached the modified Engel class Ⅰ. Conclusion Epileptic seizures are the main clinical manifestations of cerebral sparganosis. Clinical diagnosis can be made based on serum immunological examination and imaging features. Surgery is an effective approach to remove live worms and cure the disease.

Key words: Cerebral sparganosis, Live worm, Epilepsy, Magnetic resonance imaging, Microsurgery