A 9-year-old Buyi boy, a student from Guizhou Province (a Paragonimus-endemic region), presented to the First Affiliated Hospital of Guizhou Medical University in June 2024 with sudden-onset right-sided limb weakness. His medical history was significant for chronic consumption of untreated water and raw crustaceans (shrimp and crabs). Initial cranial CT revealed left frontoparietal hemorrhage, while chest CT demonstrated a cavity in the left lower lung lobe. Laboratory tests showed marked eosinophilia (18.40%). Initially diagnosed as “intracerebral hemorrhage of unknown etiology”, he was treated with sodium valproate oral solution (20 ml/d) for 3 weeks, leading to symptomatic remission. In October, the patient was readmitted due to recurrent intracerebral hemorrhage with vomiting. Laboratory tests showed marked eosinophilia (18.10%). Enhanced brain MRI showed multiple ring-enhancing lesions in the left frontotemporoparietoccipital lobes, and chest CT revealed migratory pulmonary cavitations. Serological confirmation via peripheral blood ELISA showed positive Paragonimus IgG antibody, establishing the diagnosis of cerebro-thoracic paragonimiasis. Treatment consisted of praziquantel [75 mg/(kg·d) orally, divided into three doses daily for 3 days, repeated after a 1-week interval], dexamethasone tablets (0.75 mg/d orally), and continued sodium valproate (20 ml/d orally). At 1-month follow-up, imaging showed resolution of the intracerebral hemorrhage and reduction in pulmonary lesions, with seroconversion of Paragonimus antibody. Six months post-discharge, the child exhibited full recovery of right limb muscle strength without recurrent hemorrhage.