title: Severe form of radiculo - myelo - neuropathy with meningo - encephalitis secondary to Angiostrongylus cantonensis infection: unusual corpus callosal lesions and serial magnetic resonance imaging findings.
abstract: A 43-year-old man presented with the symptoms of recurrent lower abdominal pain, malaise and loss of appetite of 3-week duration, followed by acute onset of generalized paresthesias, fever and headache which progressed over few days to quadriparesis, altered sensorium, urinary and fecal incontinence. He had consumed raw tongue, liver, gall bladder and testicles of monitor lizard (Varanus bengalensis). Blood picture showed eosinophilia and cerebrospinal fluid (CSF) analysis revealed elevated protein and eosinophilia. Serum and CSF serology was positive for angiostrongyliasis. Magnetic resonance imaging showed focal hyperintense lesions in the corpus callosum and brainstem and an enhancing lesion in the cerebellum. Post-contrast T1-weighted axial images of spine showed evidence of cervical cord hyperintense lesions and root enhancement. Susceptibility weighted images/phase images showed unusual feature of multiple hemorrhagic lesions in the posterior fossa and supratentorial areas. Diffusion showed no restriction of corpus callosal lesions. Patient was treated with the high dose parenteral steroids with albendazole and at 6-month follow-up and had a remarkable recovery.
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: Atchayaram
authors.initials: A
authors.lastname: Nalini
authors.forename: Anil
authors.initials: A
authors.lastname: Ramakrishna
authors.forename: Paron
authors.initials: P
authors.lastname: Dekumoy
authors.forename: Raju Ravi
authors.initials: RR
authors.lastname: Kumar
authors.forename: Wallop
authors.initials: W
authors.lastname: Pakdee
authors.forename: Jitender
authors.initials: J
authors.lastname: Saini
authors.forename: Vinay S
authors.initials: VS
authors.lastname: Hegde
mesh_terms: D000328:Adult; D017185:Angiostrongylus cantonensis / Q000472:pathogenicity*; D000818:Animals; D003337:Corpus Callosum / Q000469:parasitology* / Q000473:pathology*; D004660:Encephalitis / Q000209:etiology* / Q000469:parasitology; D004802:Eosinophilia / Q000150:complications / Q000175:diagnosis; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D013118:Spinal Cord Diseases / Q000150:complications*; D017206:Strongylida Infections / Q000150:complications*