title: The return of an old worm: cerebral paragonimiasis presenting with intracerebral hemorrhage.
abstract: Paragonimiasis is caused by ingesting crustaceans, which are the intermediate hosts of Paragonimus. The involvement of the brain was a common presentation in Korea decades ago, but it becomes much less frequent in domestic medical practices. We observed a rare case of cerebral paragonimiasis manifesting with intracerebral hemorrhage. A 10-yr-old girl presented with sudden-onset dysarthria, right facial palsy and clumsiness of the right hand. Brain imaging showed acute intracerebral hemorrhage in the left frontal area. An occult vascular malformation or small arteriovenous malformation compressed by the hematoma was initially suspected. The lesion progressed for over 2 months until a delayed surgery was undertaken. Pathologic examination was consistent with cerebral paragonimiasis. After chemotherapy with praziquantel, the patient was monitored without neurological deficits or seizure attacks for 6 months. This case alerts practicing clinicians to the domestic transmission of a forgotten parasitic disease due to environmental changes.
authors.affiliation: Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea.
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Koh
authors.forename: Seung-Ki
authors.initials: SK
authors.lastname: Kim
authors.forename: Kyu-Chang
authors.initials: KC
authors.lastname: Wang
authors.forename: Jong-Yil
authors.initials: JY
authors.lastname: Chai
authors.forename: Sangjoon
authors.initials: S
authors.lastname: Chong
authors.forename: Sung-Hye
authors.initials: SH
authors.lastname: Park
authors.forename: Jung-Eun
authors.initials: JE
authors.lastname: Cheon
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Phi
mesh_terms: D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D001921:Brain / Q000469:parasitology / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000209:etiology*; D002648:Child; D004401:Dysarthria / Q000209:etiology; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D010237:Paragonimiasis / Q000175:diagnosis* / Q000188:drug therapy / Q000469:parasitology; D010238:Paragonimus / Q000302:isolation & purification; D011223:Praziquantel / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D054079:Vascular Malformations / Q000209:etiology
chemical_list: D000871:Anthelmintics; D011223:Praziquantel