Magnetic resonance imaging findings and clinical manifestations in cerebral angiostrongyliasis from Dali, China

Abstract

Purpose To analyze magnetic resonance imaging (MRI) findings and clinical diagnosis and treatment data relating to Angiostrongylus cantonensis infection to gain insight into the disease. Materials and Methods We retrospectively analyzed the epidemiology, clinical manifestations, diagnosis and treatment data, imaging manifestations, and outcomes of 27 patients who were clinically diagnosed with angiostrongyliasis and who underwent contrast‐enhanced brain MRI. Results Patients with A. cantonensis infection had a history of eating raw mollusks in the endemic area, and they mainly presented with dizziness and headache of varying degrees and vomiting ( n = 7). Laboratory examinations revealed increased peripheral blood and cerebrospinal fluid (CSF) eosinophils, as well as increased CSF protein levels. Brain MRI findings mainly included eosinophilic meningitis, whereas linear or nodular enhancement of the pia mater was observed in enhanced T1‐weighted and fluid‐attenuated inversion recovery images, accompanied by encephalitis or vasculitis. Meningitis manifested as multiple, thickened flow voids around the meninges, and contrast‐enhanced scans showed substantial enhancement in intracranial dilated and hyperplastic blood vessels. Conclusion The possibility of A. cantonensis infection should be considered in the effective use of albendazole or mebendazole as a treatment. Combining clinical history with laboratory examination is helpful in diagnosing A. cantonensis infection. A final definite diagnosis can be confirmed by detecting larvae in the CSF. The administration of corticosteroids during pathogen therapy can substantially reduce the therapeutic response.

Guidelines for the diagnosis and treatment of neuroangiostrongyliasis: updated recommendations

“…There are no pathognomonic radiographic findings of NAS but magnetic resonance imaging (MRI) of the brain may demonstrate the following: leptomeningeal enhancement in post-contrast studies; increased signal intensity in the subcortical white matter on T2 weighted and FLAIR images; and nodular, linear or hockey stick-like lesions in the white matter on gadolinium-enhanced T1 images (Lai et al ., 2007 ; Tsai et al ., 2011 ; Yang et al ., 2019 ; McAuliffe et al ., 2019 ). Brain MRI may also be normal during the first few weeks of illness.…”

Optimizing Laboratory Diagnostic Services for Infectious Meningitis in the Meningitis Belt of sub-Saharan Africa

“…1,2 Considering steroid therapy in order to prevent deafness and brain damage, differential diagnosis for BM and VM within 4 h of antibiotics is needed. 3,4 At the time of the first recorded outbreak of infectious meningitis in Geneva in 1805, there were no records of laboratory identification of the causative pathogen(s). 5 However, reports from scientifically advanced countries such as the United Kingdom (U.K.) and the United States (U.S.) show that following the roll out of bacterial vaccines, viral meningitis became more prevalent than bacterial meningitis.…”

“…The authors recommended the identification of parasite larvae in CSF because a definitive diagnosis with the administration of corticosteroids during pathogen therapy can substantially reduce the therapeutic response. 4 Beside migrating larvae of nematodes, other causes of PM include protozoan parasites such as Entamoeba species and Plasmodium species. Like BM, the rapid and precise identification of the etiologic agent of PM is very important for guiding clinical chemotherapy.…”

“…BM poses the most threat because of the rapid onset (most victims die within 24–48 h of the beginning of symptoms). Choices and concerns for treatment options and expected outcomes in infectious meningitis, particularly in regard to antimicrobials with improved CNS penetration, are important in neurology. , Considering steroid therapy in order to prevent deafness and brain damage, differential diagnosis for BM and VM within 4 h of antibiotics is needed. , …”

“…Snails ( Bulimulus tenuissimus ) and rats ( Rattus novergicus ) are well-documented intermediate hosts of A. cantonensis . The authors recommended the identification of parasite larvae in CSF because a definitive diagnosis with the administration of corticosteroids during pathogen therapy can substantially reduce the therapeutic response . Beside migrating larvae of nematodes, other causes of PM include protozoan parasites such as Entamoeba species and Plasmodium species.…”